Provider Demographics
NPI:1659851590
Name:MOMPLAISIR, JONATHAN OBED (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:OBED
Last Name:MOMPLAISIR
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 1:1005 E NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6101
Mailing Address - Country:US
Mailing Address - Phone:956-686-6510
Mailing Address - Fax:956-686-2942
Practice Address - Street 1:1005 E NOLANA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6101
Practice Address - Country:US
Practice Address - Phone:956-686-6510
Practice Address - Fax:956-686-2942
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1310571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist