Provider Demographics
NPI:1588058291
Name:LARIOS, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LARIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 E TYLER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7211
Mailing Address - Country:US
Mailing Address - Phone:956-440-0580
Mailing Address - Fax:956-440-0584
Practice Address - Street 1:2117 E TYLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7211
Practice Address - Country:US
Practice Address - Phone:956-440-0580
Practice Address - Fax:956-440-0584
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2066972225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2066972OtherSTATE LICENSE