Healthcare Provider Details

I. General information

NPI: 1235695628
Provider Name (Legal Business Name): ELIZABETH MARIE ESCAMILLA LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE ESCAMILLA-RODRIGUEZ LPTA

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 SID KATZ DR
SAN ANTONIO TX
78229-3370
US

IV. Provider business mailing address

4711 SID KATZ DR
SAN ANTONIO TX
78229-3370
US

V. Phone/Fax

Practice location:
  • Phone: 210-397-2428
  • Fax:
Mailing address:
  • Phone: 210-397-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2063998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: