Healthcare Provider Details

I. General information

NPI: 1538979554
Provider Name (Legal Business Name): ISRAEL MALDONADO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15803 WINDERMERE DR
PFLUGERVILLE TX
78660-2402
US

IV. Provider business mailing address

12345 LAMPLIGHT VILLAGE AVE APT 1121
AUSTIN TX
78758-2568
US

V. Phone/Fax

Practice location:
  • Phone: 512-647-1720
  • Fax:
Mailing address:
  • Phone: 512-364-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: