Provider Demographics
NPI:1811388655
Name:LUNA, PEDRO JR (PTA)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:LUNA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2924
Mailing Address - Country:US
Mailing Address - Phone:361-445-3969
Mailing Address - Fax:361-445-3970
Practice Address - Street 1:3403 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 301
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2924
Practice Address - Country:US
Practice Address - Phone:361-445-3969
Practice Address - Fax:361-445-3970
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2102696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant