Provider Demographics
NPI:1720389901
Name:SANANIKONE, AIRIEL D (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AIRIEL
Middle Name:D
Last Name:SANANIKONE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 BRIAR FOREST DR. APT # 1108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:318-447-2167
Mailing Address - Fax:
Practice Address - Street 1:1718 FRY RD STE 335
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5849
Practice Address - Country:US
Practice Address - Phone:281-492-2828
Practice Address - Fax:281-492-2825
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1201550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist