Provider Demographics
NPI:1154792661
Name:TORRES, NIA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:MARIE
Last Name:TORRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4031
Mailing Address - Country:US
Mailing Address - Phone:575-779-5895
Mailing Address - Fax:
Practice Address - Street 1:2456 CARTER AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4031
Practice Address - Country:US
Practice Address - Phone:575-779-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013645225100000X
COPT4702225100000X
WYPT-1945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist