Provider Demographics
NPI:1497033633
Name:YOUSEFZADEH, JONSON (PT, DPT, COMPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JONSON
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:M
Credentials:PT, DPT, COMPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 S MO PAC EXPY APT 1328
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7616 LBJ FWY STE 640
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1184
Practice Address - Country:US
Practice Address - Phone:214-960-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26669225100000X
TX1250831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist