Provider Demographics
NPI:1659640993
Name:NAVARRETE, MAYRA CAROLINA (DPT)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:CAROLINA
Last Name:NAVARRETE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 DESERT SAGE DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6554
Mailing Address - Country:US
Mailing Address - Phone:915-329-6659
Mailing Address - Fax:
Practice Address - Street 1:780 N RESLER DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7196
Practice Address - Country:US
Practice Address - Phone:915-626-5358
Practice Address - Fax:915-581-3862
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist