Provider Demographics
NPI:1932697349
Name:CAMPOS, JOSE LUIS JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:CAMPOS
Suffix:JR
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 1:10501 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6324
Mailing Address - Country:US
Mailing Address - Phone:956-961-9950
Mailing Address - Fax:
Practice Address - Street 1:4004 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-4962
Practice Address - Country:US
Practice Address - Phone:956-683-9339
Practice Address - Fax:956-683-9329
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty