Provider Demographics
NPI:1316484645
Name:ESPINOSA, EDDIE
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19615 CYPRESS BOUGH DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1201
Mailing Address - Country:US
Mailing Address - Phone:832-721-2641
Mailing Address - Fax:
Practice Address - Street 1:19615 CYPRESS BOUGH DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1201
Practice Address - Country:US
Practice Address - Phone:832-721-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2125771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant