Provider Demographics
NPI:1144748021
Name:ANDINO, NILSA GRISEL (PT)
Entity type:Individual
Prefix:
First Name:NILSA
Middle Name:GRISEL
Last Name:ANDINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 SHERBROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4121
Mailing Address - Country:US
Mailing Address - Phone:915-329-7712
Mailing Address - Fax:
Practice Address - Street 1:4601 HONDO PASS DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1457
Practice Address - Country:US
Practice Address - Phone:915-545-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist