Provider Demographics
NPI:1538979554
Name:MALDONADO, ISRAEL (DPT)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 LAMPLIGHT VILLAGE AVE APT 1121
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2568
Mailing Address - Country:US
Mailing Address - Phone:512-364-6416
Mailing Address - Fax:
Practice Address - Street 1:15803 WINDERMERE DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2402
Practice Address - Country:US
Practice Address - Phone:512-647-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist