Provider Demographics
NPI:1760492433
Name:VALENZUELA-LAO, FAYE (PT)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:VALENZUELA-LAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12308 SHADY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7803
Mailing Address - Country:US
Mailing Address - Phone:713-382-7421
Mailing Address - Fax:281-485-4818
Practice Address - Street 1:8619 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8782
Practice Address - Country:US
Practice Address - Phone:281-485-4818
Practice Address - Fax:281-485-5446
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11063912251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics