Provider Demographics
NPI:1639746803
Name:SEANEZ, ESTEBAN
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:SEANEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WOOD DRAKE PL
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4972
Mailing Address - Country:US
Mailing Address - Phone:915-526-4179
Mailing Address - Fax:
Practice Address - Street 1:20639 KUYKENDAHL RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3587
Practice Address - Country:US
Practice Address - Phone:832-698-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2140319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant