Provider Demographics
NPI:1740981208
Name:MACHORRO, ERNEST (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:MACHORRO
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 560 BOX 500
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96376-0006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TORII STATION
Practice Address - Street 2:UNIT 35123, BUILDING 103
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96376-5123
Practice Address - Country:US
Practice Address - Phone:315-652-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT74172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer