Individual
LISETTE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
512 S WESTGATE DR STE A, WESLACO, TX 78596-6296
(956) 351-5050
Mailing address
2604 S BRIDGE AVE APT 7, WESLACO, TX 78596-8134
(956) 463-7757
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2084953
TX
Other
Enumeration date
07/14/2018
Last updated
07/14/2018
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