Provider Demographics
NPI:1932624095
Name:OBREGON, JOEL HOMERO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:HOMERO
Last Name:OBREGON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 W SAGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-2696
Mailing Address - Country:US
Mailing Address - Phone:361-522-7401
Mailing Address - Fax:
Practice Address - Street 1:6014 45TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3773
Practice Address - Country:US
Practice Address - Phone:806-780-7433
Practice Address - Fax:806-780-7434
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist