Provider Demographics
NPI:1083184030
Name:RESENDEZ, MATILDE
Entity Type:Individual
Prefix:
First Name:MATILDE
Middle Name:
Last Name:RESENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 POST OAK RD APT A
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78653-5307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2637 POST OAK RD
Practice Address - Street 2:
Practice Address - City:WEBBERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78653-5307
Practice Address - Country:US
Practice Address - Phone:817-657-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist