Provider Demographics
NPI:1891457362
Name:CARINO, JOSE ANGELO
Entity Type:Individual
Prefix:
First Name:JOSE ANGELO
Middle Name:
Last Name:CARINO
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 1:3300 S GARRISON RD APT 5201
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2727
Mailing Address - Country:US
Mailing Address - Phone:347-510-1486
Mailing Address - Fax:
Practice Address - Street 1:3300 S GARRISON RD APT 5201
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2727
Practice Address - Country:US
Practice Address - Phone:347-510-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2165364225200000X
TX1373026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant