Organization
PAUL V BONARRIGO
Active
Other names
Sports and Back Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL V BONARRIGO LPT (OWNER)
(979) 776-2225
Entity
Organization
Contact information
Practice address
2011A E VILLA MARIA RD, BRYAN, TX 77802-2541
(979) 776-2225
(979) 776-7945
Mailing address
2011-A E VILLA MARIA, BRYAN, TX 77802
(979) 776-2225
(979) 776-7945
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1005635
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0092QS
BLUE CROSS
TX
Enumeration date
11/07/2006
Last updated
04/14/2008
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