Provider Demographics
NPI:1942623426
Name:ALCANTARA, EDWARD REYES (DPT)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:REYES
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 MILAM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6216
Mailing Address - Country:US
Mailing Address - Phone:832-855-2504
Mailing Address - Fax:
Practice Address - Street 1:4918 MILAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6216
Practice Address - Country:US
Practice Address - Phone:832-855-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31076225100000X
TX1250143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist