Provider Demographics
NPI:1689152605
Name:CANTU, LIZETH (PTA)
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:CANTU
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 1:910 E 8TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4346
Mailing Address - Country:US
Mailing Address - Phone:956-447-3565
Mailing Address - Fax:
Practice Address - Street 1:926 W SAM HOUSTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5201
Practice Address - Country:US
Practice Address - Phone:956-702-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2128951225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant