Provider Demographics
NPI:1760659262
Name:VALENCIA, TUDY ROMERO (PT)
Entity Type:Individual
Prefix:MR
First Name:TUDY
Middle Name:ROMERO
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 HARRIS AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4648
Mailing Address - Country:US
Mailing Address - Phone:713-477-8889
Mailing Address - Fax:281-476-7789
Practice Address - Street 1:615 HARRIS AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4648
Practice Address - Country:US
Practice Address - Phone:713-477-8889
Practice Address - Fax:281-476-7789
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist