Provider Demographics
NPI:1750757787
Name:BUENTELLO, RICO ANDRES (PT, DPT)
Entity type:Individual
Prefix:
First Name:RICO
Middle Name:ANDRES
Last Name:BUENTELLO
Suffix:
Gender:M
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 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3258
Mailing Address - Country:US
Mailing Address - Phone:210-477-5151
Mailing Address - Fax:210-477-5152
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3258
Practice Address - Country:US
Practice Address - Phone:210-477-5151
Practice Address - Fax:210-477-5152
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1262165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist