Provider Demographics
NPI:1578257564
Name:NIETO, EDWARD ALEXANDER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:NIETO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 MEADOW RD APT 5318
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3773
Mailing Address - Country:US
Mailing Address - Phone:210-381-2260
Mailing Address - Fax:
Practice Address - Street 1:9301 NORTH CENTRAL EXPRESSWAY
Practice Address - Street 2:TOWER II, 4TH FLOOR, SUITE 451
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-397-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1377372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist