Provider Demographics
NPI:1205499134
Name:ELARBA, JORGE ANDRES (DPT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ANDRES
Last Name:ELARBA
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 1:308 WOLVERINE PASS
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4032
Mailing Address - Country:US
Mailing Address - Phone:512-557-2461
Mailing Address - Fax:
Practice Address - Street 1:308 WOLVERINE PASS
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4032
Practice Address - Country:US
Practice Address - Phone:512-557-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist