Provider Demographics
NPI:1366922544
Name:MARINES, MIGUEL A JR (LPTA)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:MARINES
Suffix:JR
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2523
Mailing Address - Country:US
Mailing Address - Phone:956-661-0777
Mailing Address - Fax:
Practice Address - Street 1:4232 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2523
Practice Address - Country:US
Practice Address - Phone:956-661-0777
Practice Address - Fax:956-661-0779
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098161225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant