1407688021 NPI number — DR. ALEXIS CRISTINE CISNEROS RATHMELL PT, DPT

Table of content: DR. ALEXIS CRISTINE CISNEROS RATHMELL PT, DPT (NPI 1407688021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407688021 NPI number — DR. ALEXIS CRISTINE CISNEROS RATHMELL PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CISNEROS RATHMELL
Provider First Name:
ALEXIS
Provider Middle Name:
CRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CISNEROS
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
CRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407688021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2116 GALVESTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78043-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-771-9880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5702 MCPHERSON RD STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041-6884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-725-4555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1387914 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)