Provider Demographics
NPI:1518233980
Name:CUSTODIO, MARIA VICTORIA VELOSO (PT)
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:VELOSO
Last Name:CUSTODIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 HOLLISTER ST
Mailing Address - Street 2:APT 522
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6969 HOLLISTER ST
Practice Address - Street 2:APT 522
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5300
Practice Address - Country:US
Practice Address - Phone:785-217-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017083225100000X
TX1273320225100000X
LACP000625T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist