Provider Demographics
NPI:1750684056
Name:DEL RIO, LUIS MANUEL II (PTA)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MANUEL
Last Name:DEL RIO
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-2511
Mailing Address - Country:US
Mailing Address - Phone:615-812-0371
Mailing Address - Fax:
Practice Address - Street 1:813 S DICKERSON RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1761
Practice Address - Country:US
Practice Address - Phone:615-859-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant