Provider Demographics
NPI:1558522219
Name:LONGORIA, LINDA S (PT MA OCS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:PT MA OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151132
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1132
Mailing Address - Country:US
Mailing Address - Phone:512-892-5250
Mailing Address - Fax:512-892-7183
Practice Address - Street 1:1825 FORTVIEW RD
Practice Address - Street 2:STE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7657
Practice Address - Country:US
Practice Address - Phone:512-892-5250
Practice Address - Fax:512-892-7183
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139022251X0800X
TX6024000002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177242900OtherDEPARTMENT OF LABOR
TX83661TOtherBCBS
TX0018DZOtherBCBS GROUP #