Provider Demographics
NPI:1629273057
Name:TORIBIO, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TORIBIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6204
Mailing Address - Country:US
Mailing Address - Phone:409-982-8878
Mailing Address - Fax:
Practice Address - Street 1:5957 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6204
Practice Address - Country:US
Practice Address - Phone:409-982-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2094225100000X
TX1181390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2038895Medicaid
TX2038895Medicaid