Individual
ANDREW EDWARD TABASCO PANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1200 E LANE ST, LAREDO, TX 78040-7210
(956) 722-0031
Mailing address
1601 FREMONT ST APT 208, LAREDO, TX 78043-2660
(805) 710-0793
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1293860
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1293860
PT LICENSE NUMBER
TX
Enumeration date
09/13/2018
Last updated
09/13/2018
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