Provider Demographics
NPI:1538377486
Name:SETEYESH, MEHRZAD (PT)
Entity type:Individual
Prefix:
First Name:MEHRZAD
Middle Name:
Last Name:SETEYESH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 TESORO AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9717
Mailing Address - Country:US
Mailing Address - Phone:956-350-2222
Mailing Address - Fax:
Practice Address - Street 1:535 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2483
Practice Address - Country:US
Practice Address - Phone:956-982-6982
Practice Address - Fax:956-982-0436
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist