Provider Demographics
NPI:1982142089
Name:HORTALEZA, NIGEL PAUL FILLER
Entity type:Individual
Prefix:
First Name:NIGEL PAUL
Middle Name:FILLER
Last Name:HORTALEZA
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 1:4704 GLENLEA DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1728
Mailing Address - Country:US
Mailing Address - Phone:832-508-3071
Mailing Address - Fax:
Practice Address - Street 1:4100 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5102
Practice Address - Country:US
Practice Address - Phone:903-831-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4257225100000X
TX1284298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist