Provider Demographics
NPI:1215185947
Name:FLORES, AZALEA IRIS (PT)
Entity Type:Individual
Prefix:
First Name:AZALEA
Middle Name:IRIS
Last Name:FLORES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 E SOUTHCROSS BLVD
Mailing Address - Street 2:B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3521
Mailing Address - Country:US
Mailing Address - Phone:210-337-7953
Mailing Address - Fax:210-337-7966
Practice Address - Street 1:12315 JUDSON RD STE 200
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3206
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist