Provider Demographics
NPI:1437300928
Name:LIBORO, EDUARDO ABELEDA (PT)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ABELEDA
Last Name:LIBORO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6204
Mailing Address - Country:US
Mailing Address - Phone:409-982-8878
Mailing Address - Fax:409-982-5119
Practice Address - Street 1:6755 PHELAN BLVD STE 28
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6078
Practice Address - Country:US
Practice Address - Phone:409-861-1009
Practice Address - Fax:409-861-4009
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009675A171W00000X
NY019088225100000X
TX1211528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03160161Medicaid