Provider Demographics
NPI:1346453057
Name:ONOFRE PHYSICAL THERAPY CLINIC
Entity Type:Organization
Organization Name:ONOFRE PHYSICAL THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONOFRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:806-385-3746
Mailing Address - Street 1:1506 S SUNSET AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4813
Mailing Address - Country:US
Mailing Address - Phone:806-385-3746
Mailing Address - Fax:806-385-6176
Practice Address - Street 1:1506 S SUNSET AVE STE B
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4813
Practice Address - Country:US
Practice Address - Phone:806-385-3746
Practice Address - Fax:806-385-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605670000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030JNOtherBC BS OF TX GROUP NUMBER
TX153401801Medicaid
TX153401801Medicaid