Provider Demographics
NPI:1891070827
Name:PRUNEDA, OLIVERIO RENE (PTA)
Entity Type:Individual
Prefix:MR
First Name:OLIVERIO
Middle Name:RENE
Last Name:PRUNEDA
Suffix:
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 1:317 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-4840
Mailing Address - Country:US
Mailing Address - Phone:956-283-7311
Mailing Address - Fax:956-283-8858
Practice Address - Street 1:317 E PARK AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-4840
Practice Address - Country:US
Practice Address - Phone:956-283-7311
Practice Address - Fax:956-283-8858
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant