Provider Demographics
NPI:1053963231
Name:MEDRANO, ANGELICA (PT)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2453
Mailing Address - Country:US
Mailing Address - Phone:713-297-6792
Mailing Address - Fax:
Practice Address - Street 1:4027 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6850
Practice Address - Country:US
Practice Address - Phone:409-899-2765
Practice Address - Fax:409-924-9468
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist