Provider Demographics
NPI:1235673823
Name:AGUILAR, RAIZA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8539 N CAPITAL OF TEXAS HWY APT 1079
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7991
Mailing Address - Country:US
Mailing Address - Phone:512-751-1247
Mailing Address - Fax:
Practice Address - Street 1:11400 CONCORDIA UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1887
Practice Address - Country:US
Practice Address - Phone:512-313-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT57972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer