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NPI Code Detail

MEDICARE: KENNETH QUELIZA PT

MEDICARE: KENNETH QUELIZA PT
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
1225100000XPhysical Therapist1299130TX

General Provider Information

NPI Number : 1417460999
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH QUELIZA PT
Provider Business Mailing Address
First Line : 12952 BANDERA RD STE 107
Second Line :
City : HELOTES
State : TX
Zip : 78023-4733
Country : US
Telephone Number : 210-372-9600
Fax Number :
Provider Business Practice Location Address
First Line : 12952 BANDERA RD STE 107
Second Line :
City : HELOTES
State : TX
Zip : 78023-4733
Country : US
Telephone Number : 210-372-9600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2017
Last Update Date : 11/07/2017

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Directions to “ KENNETH QUELIZA PT” Practice Location

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