Provider Demographics
NPI:1730804063
Name:FLORES, ROGERIO LAZARO (PTA)
Entity type:Individual
Prefix:MR
First Name:ROGERIO
Middle Name:LAZARO
Last Name:FLORES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S IH 35
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-6601
Mailing Address - Country:US
Mailing Address - Phone:830-334-3617
Mailing Address - Fax:
Practice Address - Street 1:200 S IH 35
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6601
Practice Address - Country:US
Practice Address - Phone:830-334-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051438225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant