Provider Demographics
NPI:1598886442
Name:PENA, VERONICA ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:ELIZABETH
Last Name:PENA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 377
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-9732
Mailing Address - Country:US
Mailing Address - Phone:956-472-0177
Mailing Address - Fax:
Practice Address - Street 1:18360 FM 493 SUITE 3
Practice Address - Street 2:
Practice Address - City:LA BLANCA
Practice Address - State:TX
Practice Address - Zip Code:78558
Practice Address - Country:US
Practice Address - Phone:956-262-1192
Practice Address - Fax:956-262-9226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2020152225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant