Provider Demographics
NPI:1750774857
Name:FUNCTIONAL GAINZ THERAPEUTICS, LLC
Entity type:Organization
Organization Name:FUNCTIONAL GAINZ THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-702-5167
Mailing Address - Street 1:2708 BAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5538
Mailing Address - Country:US
Mailing Address - Phone:956-702-5167
Mailing Address - Fax:956-702-5206
Practice Address - Street 1:944 W NOLANA LOOP
Practice Address - Street 2:SUITE F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7408
Practice Address - Country:US
Practice Address - Phone:956-702-5167
Practice Address - Fax:956-702-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health