Provider Demographics
NPI:1760282750
Name:AGREDANO, CARLOS JR
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:AGREDANO
Suffix:JR
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 1:1611 BACALAR DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5273
Mailing Address - Country:US
Mailing Address - Phone:956-652-4860
Mailing Address - Fax:
Practice Address - Street 1:101 W HILLSIDE RD STE 6B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3181
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2156152225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty