Provider Demographics
NPI:1962877704
Name:ANDINO, WILFREDO (PTA)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:ANDINO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 MURCHISON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2921
Mailing Address - Country:US
Mailing Address - Phone:915-533-7465
Mailing Address - Fax:915-534-1238
Practice Address - Street 1:1720 MURCHISON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2921
Practice Address - Country:US
Practice Address - Phone:915-533-7465
Practice Address - Fax:915-534-1238
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant