Provider Demographics
NPI:1538710868
Name:SANDOVAL CARROLL, PAUL ROBERT
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:SANDOVAL CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-3429
Mailing Address - Country:US
Mailing Address - Phone:956-897-3282
Mailing Address - Fax:
Practice Address - Street 1:800 E DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2262
Practice Address - Country:US
Practice Address - Phone:956-618-1242
Practice Address - Fax:956-618-1360
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2147349225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant