Provider Demographics
NPI:1235695628
Name:ESCAMILLA, ELIZABETH MARIE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:ESCAMILLA-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:4711 SID KATZ DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3370
Mailing Address - Country:US
Mailing Address - Phone:210-397-2428
Mailing Address - Fax:
Practice Address - Street 1:4711 SID KATZ DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3370
Practice Address - Country:US
Practice Address - Phone:210-397-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2063998225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2063998OtherPTA LICENSE