Provider Demographics
NPI:1700635919
Name:JURADO, MARIN RODRIGUEZ
Entity type:Individual
Prefix:
First Name:MARIN
Middle Name:RODRIGUEZ
Last Name:JURADO
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 1:3457 GAYS WAY
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1760
Mailing Address - Country:US
Mailing Address - Phone:325-370-4926
Mailing Address - Fax:
Practice Address - Street 1:2617 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5109
Practice Address - Country:US
Practice Address - Phone:325-437-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant