Provider Demographics
NPI:1134903123
Name:REYES, PAMELA MANOSCA (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MANOSCA
Last Name:REYES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 WONDER WORLD DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7694
Mailing Address - Country:US
Mailing Address - Phone:512-753-3539
Mailing Address - Fax:
Practice Address - Street 1:1340 WONDER WORLD DR STE 2100
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7694
Practice Address - Country:US
Practice Address - Phone:512-753-3539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1376064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist