Individual
MR. JOSE ENRIQUE PORTALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
901 WILDCAT WAY, KENNEDALE, TX 76060-5848
(817) 563-8133
(817) 563-8133
Mailing address
4932 BOLERO CT, FORT WORTH, TX 76135-2545
(817) 823-2563
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6642
TX
Other
Enumeration date
01/31/2018
Last updated
01/31/2018
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