Individual
MR. JONATHAN REX CARLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10670 SLATER AVE, FOUNTAIN VALLEY, CA 92708-4806
(714) 586-2498
Mailing address
10670 SLATER AVE, FOUNTAIN VALLEY, CA 92708-4806
(714) 586-2498
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2173815
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2173815
TEXAS BOARD OF PHYSICAL THERAPY
TX
Enumeration date
02/01/2023
Last updated
02/01/2023
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