Provider Demographics
NPI:1629123641
Name:RAMOS, ELI (PT)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BANGOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-4819
Mailing Address - Country:US
Mailing Address - Phone:210-435-7739
Mailing Address - Fax:
Practice Address - Street 1:1655 SELFRIDGE AVE
Practice Address - Street 2:LACKLAND AFB
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-5286
Practice Address - Country:US
Practice Address - Phone:210-292-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist