Individual
JESSE BALDERAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
920 E AVENUE L, SILSBEE, TX 77656-5014
(409) 385-5571
Mailing address
431 CLUB LAKE DR, ROCKPORT, TX 78382-7376
(361) 463-9205
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
2023208
TX
225200000X
Physical Therapy Assistant
Primary
2023208
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A63821026
THERAPY
—
Enumeration date
02/11/2019
Last updated
02/11/2019
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