Organization
EASTSIDE PHYSIOTHERAPY CLINIC
Active
Organization
EASTSIDE PHYSIOTHERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE JUAREZ (ADMINISTRATOR)
(915) 842-0504
Entity
Organization
Contact information
Practice address
1721 N LEE TREVINO DR STE B, EL PASO, TX 79936-4564
(915) 590-1910
(915) 225-6422
Mailing address
1721 N LEE TREVINO DR STE B, EL PASO, TX 79936-4564
(915) 590-1910
(915) 225-6422
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1147100
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2802654-01
—
TX
01
—
P00194843
RAILROAD MEDICARE PART B
TX
Enumeration date
02/07/2012
Last updated
02/07/2012
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