Provider Demographics
NPI:1558303792
Name:LUGO, MARY L (PT,)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:LUGO
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EMBASSY OAKS
Mailing Address - Street 2:202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2040
Mailing Address - Country:US
Mailing Address - Phone:210-490-4738
Mailing Address - Fax:210-490-5231
Practice Address - Street 1:415 EMBASSY OAKS
Practice Address - Street 2:202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2040
Practice Address - Country:US
Practice Address - Phone:210-490-4738
Practice Address - Fax:210-490-5231
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1094498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4789OtherBCBS
TX8T4789OtherBCBS
TXQ48981Medicare UPIN