Provider Demographics
NPI:1548571961
Name:MAGANA, ANTONIO JOSE (MPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOSE
Last Name:MAGANA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SHARONDALE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4210
Mailing Address - Country:US
Mailing Address - Phone:915-227-2266
Mailing Address - Fax:
Practice Address - Street 1:6310 N MESA ST STE C2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4555
Practice Address - Country:US
Practice Address - Phone:915-227-2266
Practice Address - Fax:915-207-1435
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181643172V00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172V00000XOther Service ProvidersCommunity Health Worker