Provider Demographics
NPI:1669547725
Name:PRIETO, LESTER O (PHYSICAL THERAPIST P)
Entity type:Individual
Prefix:MR
First Name:LESTER
Middle Name:O
Last Name:PRIETO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BROWN
Mailing Address - Street 2:BLDG 2A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-544-2981
Mailing Address - Fax:915-542-0575
Practice Address - Street 1:1717 BROWN
Practice Address - Street 2:BLDG 2A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-544-2981
Practice Address - Fax:915-542-0575
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0876070-1Medicaid
650014Medicare ID - Type Unspecified