Provider Demographics
NPI:1528394657
Name:VALERIO, ANISSA RENEE (PT)
Entity Type:Individual
Prefix:MS
First Name:ANISSA
Middle Name:RENEE
Last Name:VALERIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANISSA
Other - Middle Name:RENEE
Other - Last Name:YNFANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-0211
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-253-3888
Practice Address - Fax:210-253-3889
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX818T78OtherBLUE CROSS BLUE SHIELD
TX211683201Medicaid
TX211683201Medicaid