Provider Demographics
NPI:1396806550
Name:VICENCIO, DELIA ELISABETH (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DELIA
Middle Name:ELISABETH
Last Name:VICENCIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1082 WHIRL AWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7830
Mailing Address - Country:US
Mailing Address - Phone:915-859-1838
Mailing Address - Fax:915-859-1838
Practice Address - Street 1:1082 WHIRL AWAY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7830
Practice Address - Country:US
Practice Address - Phone:915-859-1838
Practice Address - Fax:915-859-1838
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist