Provider Demographics
NPI:1033361902
Name:ENRIQUEZ, LUISA MAGDALENA (PT)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:MAGDALENA
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E REDD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7221
Mailing Address - Country:US
Mailing Address - Phone:915-845-4060
Mailing Address - Fax:915-845-4065
Practice Address - Street 1:836 E REDD RD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-845-4060
Practice Address - Fax:915-845-4065
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist