Provider Demographics
NPI:1619518966
Name:JAVIER-ANDERSON, PRINCESS ERIKA
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:ERIKA
Last Name:JAVIER-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRINCESS
Other - Middle Name:E
Other - Last Name:JAVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6302 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3245
Mailing Address - Country:US
Mailing Address - Phone:210-364-7392
Mailing Address - Fax:
Practice Address - Street 1:6302 STIRRUP LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3245
Practice Address - Country:US
Practice Address - Phone:210-364-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2118627225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant