Active NPI
Renato Agcanas Maulion Jr., PT
- Physical Therapist
- Nacogdoches, TX
National Provider Identifier
1679985899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1171490
- Practice address
- 4920 NE Stallings Dr Ste 201
Nacogdoches, TX 75965-1254 - Phone
- (936) 560-1618
- Fax
- (936) 560-3554
- NPI assigned
- May 22, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1171490 | TX | Primary |
Addresses
Primary practice location
4920 NE Stallings Dr Ste 201
Nacogdoches, TX 75965-1254
Mailing address
4920 NE Stallings Dr Ste 201
Nacogdoches, TX 75965-1254
Phone (936) 560-1618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1171490 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400716800000",
"number": "1679985899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4920 NE STALLINGS DR STE 201",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651254",
"telephone_number": "936-560-1618",
"fax_number": "936-560-3554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4920 NE STALLINGS DR STE 201",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651254",
"telephone_number": "936-560-1618",
"fax_number": "936-560-3554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAULION",
"first_name": "RENATO",
"middle_name": "AGCANAS",
"name_suffix": "Jr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-22",
"last_updated": "2014-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1171490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.