Provider Demographics
NPI:1386720134
Name:ZAMORA, LETICIA (PTA)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 BLUE BONNET DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9264
Mailing Address - Country:US
Mailing Address - Phone:956-364-3461
Mailing Address - Fax:
Practice Address - Street 1:729 N 77 SUNSHINE STRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8847
Practice Address - Country:US
Practice Address - Phone:956-421-4667
Practice Address - Fax:956-421-2016
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant