Provider Demographics
NPI:1437555323
Name:CUSTODIO, MARIA CATHERINE YAZON (PT)
Entity Type:Individual
Prefix:
First Name:MARIA CATHERINE
Middle Name:YAZON
Last Name:CUSTODIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:CUSTODIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2600 ELDORADO PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7517
Mailing Address - Country:US
Mailing Address - Phone:972-984-7670
Mailing Address - Fax:972-984-7671
Practice Address - Street 1:2600 ELDORADO PKWY STE 130
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7517
Practice Address - Country:US
Practice Address - Phone:972-984-7670
Practice Address - Fax:972-984-7671
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist