Provider Demographics
NPI:1689372088
Name:LABITORIA, RYAN SILMETE
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SILMETE
Last Name:LABITORIA
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 1:2349 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-2251
Mailing Address - Country:US
Mailing Address - Phone:432-940-2473
Mailing Address - Fax:
Practice Address - Street 1:2349 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-2251
Practice Address - Country:US
Practice Address - Phone:432-940-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist