Provider Demographics
NPI:1770685893
Name:ESCOBEDO, JORGE (PT/DPT)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E. BUSINESS HWY. 83
Mailing Address - Street 2:STE. A
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-9741
Mailing Address - Country:US
Mailing Address - Phone:956-783-5455
Mailing Address - Fax:956-781-1787
Practice Address - Street 1:515 E. BUS. HWY. 83
Practice Address - Street 2:STE. A
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-9741
Practice Address - Country:US
Practice Address - Phone:956-783-5455
Practice Address - Fax:956-781-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010919101Medicaid
TX1259630001Medicare ID - Type Unspecified