Provider Demographics
NPI:1558428854
Name:TORRES, LINO (OTR)
Entity Type:Individual
Prefix:MR
First Name:LINO
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 W ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6415
Mailing Address - Country:US
Mailing Address - Phone:956-554-7529
Mailing Address - Fax:956-554-7548
Practice Address - Street 1:615 VILLA MARIA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6341
Practice Address - Country:US
Practice Address - Phone:956-554-7529
Practice Address - Fax:956-554-9548
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-12-20
Deactivation Date:2007-05-15
Deactivation Code:
Reactivation Date:2011-12-20
Provider Licenses
StateLicense IDTaxonomies
TX110086225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202848714OtherTAX ID
TX178271601Medicaid