Provider Demographics
NPI:1053893404
Name:MEZA, RUBEN SR (PTA)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MEZA
Suffix:SR
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:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:SKIDMORE
Mailing Address - State:TX
Mailing Address - Zip Code:78389
Mailing Address - Country:US
Mailing Address - Phone:361-947-3367
Mailing Address - Fax:
Practice Address - Street 1:696 FM 99,
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118
Practice Address - Country:US
Practice Address - Phone:361-947-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207323225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant