Provider Demographics
NPI:1649510520
Name:SOMOSO, NEAL BRYAN (DPT)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:BRYAN
Last Name:SOMOSO
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 1:5309 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2252
Mailing Address - Country:US
Mailing Address - Phone:956-664-1819
Mailing Address - Fax:956-994-8299
Practice Address - Street 1:5309 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2252
Practice Address - Country:US
Practice Address - Phone:956-664-1819
Practice Address - Fax:956-994-8299
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60330419225100000X
TX1224026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1224026OtherTEXAS LICENSE NUMBER