Provider Demographics
NPI:1699413294
Name:ZELEZNAK, KAELEEN (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KAELEEN
Middle Name:
Last Name:ZELEZNAK
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 ALAMO RANCH PKWY APT 3731
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4018
Mailing Address - Country:US
Mailing Address - Phone:210-412-1114
Mailing Address - Fax:
Practice Address - Street 1:14350 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2222
Practice Address - Country:US
Practice Address - Phone:210-398-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT8290OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
2000038820OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER