Provider Demographics
NPI:1043059421
Name:CORCHO CORCHO, JOSE ANTONIO (LMT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:CORCHO CORCHO
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SNAKE RIVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7746
Mailing Address - Country:US
Mailing Address - Phone:346-546-9653
Mailing Address - Fax:832-626-3627
Practice Address - Street 1:1808 SNAKE RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7746
Practice Address - Country:US
Practice Address - Phone:346-546-9653
Practice Address - Fax:832-626-3627
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT131203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist