Provider Demographics
NPI:1700513298
Name:ADDISON, NIJIERA I (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NIJIERA
Middle Name:I
Last Name:ADDISON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 OAK TREE DR APT 2206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-7362
Mailing Address - Country:US
Mailing Address - Phone:609-864-2431
Mailing Address - Fax:
Practice Address - Street 1:1533 N SHEPHERD DR STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4185
Practice Address - Country:US
Practice Address - Phone:832-831-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA18115926957972OtherDRIVERS LICENSE