Provider Demographics
NPI:1780249458
Name:REYES, HOMERO JR (PTA)
Entity type:Individual
Prefix:
First Name:HOMERO
Middle Name:
Last Name:REYES
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 BOB ROGERS DR APT 5208
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6322
Mailing Address - Country:US
Mailing Address - Phone:956-333-4495
Mailing Address - Fax:
Practice Address - Street 1:3333 BOB ROGERS DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6781
Practice Address - Country:US
Practice Address - Phone:830-213-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2131509225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant