Provider Demographics
NPI:1649265802
Name:ONOFRE, JOE (LPT)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:ONOFRE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 S SUNSET AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4899
Mailing Address - Country:US
Mailing Address - Phone:806-385-3746
Mailing Address - Fax:806-385-6176
Practice Address - Street 1:1506 S SUNSET AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4899
Practice Address - Country:US
Practice Address - Phone:806-385-3746
Practice Address - Fax:806-385-6176
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0511OtherBC BS OF TX INDIVIDUAL
TX8748B7Medicare ID - Type UnspecifiedPROVIDER NUMBER