Provider Demographics
NPI:1255939302
Name:SORTO, RENE MAURICIO
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:MAURICIO
Last Name:SORTO
Suffix:
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 1:8191 SOUTHWEST FWY STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1700
Mailing Address - Country:US
Mailing Address - Phone:713-360-6987
Mailing Address - Fax:
Practice Address - Street 1:8191 SOUTHWEST FWY STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1700
Practice Address - Country:US
Practice Address - Phone:832-762-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist