Provider Demographics
NPI:1699044628
Name:MADRID, YOLANDA (MESSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MADRID
Suffix:
Gender:F
Credentials:MESSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CAMDEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1925
Mailing Address - Country:US
Mailing Address - Phone:210-267-2199
Mailing Address - Fax:210-627-2199
Practice Address - Street 1:515 CAMDEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1925
Practice Address - Country:US
Practice Address - Phone:210-267-2199
Practice Address - Fax:210-627-2199
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801447316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist