Provider Demographics
NPI:1306384755
Name:TEXIDOR, YOLANDA (LMT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:TEXIDOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-4186
Mailing Address - Country:US
Mailing Address - Phone:470-439-6114
Mailing Address - Fax:
Practice Address - Street 1:354 JENKINS RD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-4186
Practice Address - Country:US
Practice Address - Phone:470-439-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012918225700000X, 172M00000X
PR132173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist