Provider Demographics
NPI:1013199777
Name:LUGO, ALBERTO (PT)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:LUGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 PERSHING DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2423
Mailing Address - Country:US
Mailing Address - Phone:915-566-7584
Mailing Address - Fax:915-566-7682
Practice Address - Street 1:2871 PERSHING DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2423
Practice Address - Country:US
Practice Address - Phone:915-566-7584
Practice Address - Fax:915-566-7682
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1813867Medicaid
TX8F2875Medicare PIN