Provider Demographics
NPI:1053667626
Name:BRINTS-VINER, NICOLE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRINTS-VINER
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 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:4138 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2403
Practice Address - Country:US
Practice Address - Phone:806-780-2329
Practice Address - Fax:806-780-2330
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307091402Medicaid
TXP01550212OtherMEDICARE RAILROAD
TX307091401Medicaid
TX878T95OtherBLUE CROSS BLUE SHIELD
TX540041100OtherFIRSTCARE
TX878T95OtherBLUE CROSS BLUE SHIELD