Provider Demographics
NPI:1104502541
Name:PECSON, ROEL SOBERANO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ROEL
Middle Name:SOBERANO
Last Name:PECSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4586
Mailing Address - Country:US
Mailing Address - Phone:832-766-8301
Mailing Address - Fax:
Practice Address - Street 1:4226 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4586
Practice Address - Country:US
Practice Address - Phone:832-766-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist