Provider Demographics
NPI:1063700110
Name:OBACH, RALPH ROSAURO MENDOZA (LPT)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:ROSAURO MENDOZA
Last Name:OBACH
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COUNTY ROAD 3801
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757
Mailing Address - Country:US
Mailing Address - Phone:903-894-4633
Mailing Address - Fax:903-894-4648
Practice Address - Street 1:200 COUNTY RD 3801
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757
Practice Address - Country:US
Practice Address - Phone:903-894-4633
Practice Address - Fax:903-463-4648
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist