Provider Demographics
NPI:1861976706
Name:RAMIREZ, RAYMOND (PTA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:RAMIREZ
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 1:411 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3422
Mailing Address - Country:US
Mailing Address - Phone:256-640-1402
Mailing Address - Fax:
Practice Address - Street 1:411 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3422
Practice Address - Country:US
Practice Address - Phone:256-640-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2139971225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant