Provider Demographics
NPI:1033225750
Name:AZENABOR, EDOLO O (PT)
Entity type:Individual
Prefix:MRS
First Name:EDOLO
Middle Name:O
Last Name:AZENABOR
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SALISBURY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3172
Mailing Address - Country:US
Mailing Address - Phone:214-447-7530
Mailing Address - Fax:214-447-7529
Practice Address - Street 1:532 SALISBURY DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3172
Practice Address - Country:US
Practice Address - Phone:214-447-7530
Practice Address - Fax:214-447-7529
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist