Provider Demographics
NPI:1528143641
Name:ELLORIMO, EDITH CRUZ (LPT)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:CRUZ
Last Name:ELLORIMO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MRS
Other - First Name:EDITH
Other - Middle Name:SINQUE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:1614 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3583
Mailing Address - Country:US
Mailing Address - Phone:956-423-5985
Mailing Address - Fax:
Practice Address - Street 1:729 N 77 SUNSHINE STRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8847
Practice Address - Country:US
Practice Address - Phone:956-421-4667
Practice Address - Fax:956-421-2016
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86013TOtherBCBS OF TEXAS