Provider Demographics
NPI:1396225124
Name:FLOR, JAIME INIGO
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:INIGO
Last Name:FLOR
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 1:4135 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8720
Mailing Address - Country:US
Mailing Address - Phone:903-581-8662
Mailing Address - Fax:903-581-7808
Practice Address - Street 1:4135 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8720
Practice Address - Country:US
Practice Address - Phone:903-581-8662
Practice Address - Fax:903-581-7808
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1250640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist