Provider Demographics
NPI:1831254812
Name:SOBREVILLA, ADRIAN A (PT)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:A
Last Name:SOBREVILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-3004
Mailing Address - Country:US
Mailing Address - Phone:972-563-1824
Mailing Address - Fax:972-524-5929
Practice Address - Street 1:904 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3004
Practice Address - Country:US
Practice Address - Phone:972-563-1824
Practice Address - Fax:972-524-5929
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2980Medicare ID - Type Unspecified