Provider Demographics
NPI:1609207026
Name:ALVARADO, TITO J (BBA, LPTA)
Entity Type:Individual
Prefix:
First Name:TITO
Middle Name:J
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:BBA, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 POLARIS DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2064
Mailing Address - Country:US
Mailing Address - Phone:956-750-8040
Mailing Address - Fax:956-750-8052
Practice Address - Street 1:6420 POLARIS DR STE 2A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2064
Practice Address - Country:US
Practice Address - Phone:956-750-8040
Practice Address - Fax:956-750-8052
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051360225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant