Healthcare Provider Details

I. General information

NPI: 1407216187
Provider Name (Legal Business Name): VIANEY ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W BAKER RD
BAYTOWN TX
77521-2398
US

IV. Provider business mailing address

1509 WASHINGTON DR
DEER PARK TX
77536-6455
US

V. Phone/Fax

Practice location:
  • Phone: 281-427-4373
  • Fax:
Mailing address:
  • Phone: 832-597-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2113711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: