Provider Demographics
NPI:1154690139
Name:VAZQUEZ, LILIA A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 DEW DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3909
Mailing Address - Country:US
Mailing Address - Phone:915-587-4081
Mailing Address - Fax:915-587-8344
Practice Address - Street 1:6151 DEW DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3909
Practice Address - Country:US
Practice Address - Phone:915-587-4081
Practice Address - Fax:915-587-8344
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160454801Medicaid
TX456749Medicare PIN