Individual
MR. JOHNEL VIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
16820 WEST RD, HOUSTON, TX 77095-5577
(832) 212-0770
Mailing address
16820 WEST RD # 3, HOUSTON, TX 77095-5577
(281) 856-7008
(281) 856-7108
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2060899
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2251500000X
—
TX
Enumeration date
06/22/2017
Last updated
06/23/2017
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