Provider Demographics
NPI:1003464066
Name:MINALDO, MARDEL JUDITH (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MARDEL
Middle Name:JUDITH
Last Name:MINALDO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARDEL
Other - Middle Name:JUDITH
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5726 W HAUSMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1651
Mailing Address - Country:US
Mailing Address - Phone:210-749-9414
Mailing Address - Fax:
Practice Address - Street 1:5726 W HAUSMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1651
Practice Address - Country:US
Practice Address - Phone:210-749-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist