Provider Demographics
NPI:1619112240
Name:NICART, HONORATA BARDAJE (PT)
Entity Type:Individual
Prefix:
First Name:HONORATA
Middle Name:BARDAJE
Last Name:NICART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HONORATA SHIELA
Other - Middle Name:BARDAJE
Other - Last Name:NICART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:475 RED ROSE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9366
Mailing Address - Country:US
Mailing Address - Phone:956-266-2114
Mailing Address - Fax:
Practice Address - Street 1:435 PAREDES LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2444
Practice Address - Country:US
Practice Address - Phone:956-544-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199430301OtherMEDICAID TPI
TX8F24258OtherMEDICARE PTAN