Provider Demographics
NPI:1982352332
Name:CAMPOS, ESTEBAN GABRIEL (PTA)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:GABRIEL
Last Name:CAMPOS
Suffix:
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 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4560
Mailing Address - Fax:
Practice Address - Street 1:2502 W FREDDY GONZALEZ DR STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7388
Practice Address - Country:US
Practice Address - Phone:956-381-1600
Practice Address - Fax:956-381-1616
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant