Provider Demographics
NPI:1679063549
Name:SOARES, PEDRO HENRIQUE
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:HENRIQUE
Last Name:SOARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 S STAPLES ST APT 3404
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3748
Mailing Address - Country:US
Mailing Address - Phone:361-461-1494
Mailing Address - Fax:
Practice Address - Street 1:5757 S STAPLES ST APT 3404
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3748
Practice Address - Country:US
Practice Address - Phone:361-461-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant