Individual
DESARAE ESCAMILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1136 IMPERIAL ST, PORTLAND, TX 78374-4225
(361) 215-7813
Mailing address
1136 IMPERIAL ST, PORTLAND, TX 78374-4225
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2107941
TX
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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