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NPI Code Detail

MEDICARE: MARY L LUGO P.T.,

MEDICARE:   MARY L LUGO  P.T.,
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1094498TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T4789OTHERTXBCBS

General Provider Information

NPI Number : 1558303792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L LUGO P.T.,
Provider Business Mailing Address
First Line : 415 EMBASSY OAKS
Second Line : 202
City : SAN ANTONIO
State : TX
Zip : 78216-2040
Country : US
Telephone Number : 210-490-4738
Fax Number : 210-490-5231
Provider Business Practice Location Address
First Line : 415 EMBASSY OAKS
Second Line : 202
City : SAN ANTONIO
State : TX
Zip : 78216-2040
Country : US
Telephone Number : 210-490-4738
Fax Number : 210-490-5231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 11/18/2010

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Directions to “ MARY L LUGO P.T.,” Practice Location

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