Provider Demographics
NPI:1952880965
Name:ABARCA, JOSE WALTERIO (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:WALTERIO
Last Name:ABARCA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 TONY TEJEDA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6521
Mailing Address - Country:US
Mailing Address - Phone:915-256-6319
Mailing Address - Fax:
Practice Address - Street 1:11620 TONY TEJEDA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6521
Practice Address - Country:US
Practice Address - Phone:915-256-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072155225100000X
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist