Provider Demographics
NPI:1902950793
Name:GARZA, ELAINE RODRIGUEZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:RODRIGUEZ
Last Name:GARZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:GARCIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3131 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3930
Mailing Address - Country:US
Mailing Address - Phone:210-241-7975
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-798-2273
Practice Address - Fax:210-495-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171834801Medicaid