Provider Demographics
NPI:1093976565
Name:ANCIRA, LOUIS
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:ANCIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 FRANKLIN AVE
Mailing Address - Street 2:#201
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3615 FRANKLIN AVE
Practice Address - Street 2:#201
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7364
Practice Address - Country:US
Practice Address - Phone:800-798-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2052970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant