Provider Demographics
NPI:1013635986
Name:ALTAMIRANDA MOLINA, JESUS GABRIEL (DPT)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:GABRIEL
Last Name:ALTAMIRANDA MOLINA
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 1:698 BASILICA BAY DR APT 4211
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-5020
Mailing Address - Country:US
Mailing Address - Phone:832-407-2812
Mailing Address - Fax:
Practice Address - Street 1:1309 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6134
Practice Address - Country:US
Practice Address - Phone:832-407-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist