MEDICARE: MARIA ELENA LUNA-VAZQUEZ DPT

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
1	225100000X	Physical Therapist	1405404	TX

General Provider Information

NPI Number	:	1790580280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELENA LUNA-VAZQUEZ DPT

Provider Business Mailing Address
First Line	:	PO BOX 932184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-2184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5632 EDWARDS RANCH RD STE 110
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76109-4102
Country	:	US
Telephone Number	:	817-259-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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