Individual
JAIME FABIAN ONTIVEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2117 E TYLER AVE STE B, HARLINGEN, TX 78550-7212
(956) 440-0580
Mailing address
4509 N MOOREFIELD RD, MISSION, TX 78574-4894
(956) 435-2965
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2155890
TX
Other
Enumeration date
08/11/2020
Last updated
08/11/2020
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