Provider Demographics
NPI:1821053323
Name:ELIZONDO, KARA (PTA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1822 BUCK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4951
Mailing Address - Country:US
Mailing Address - Phone:210-701-2321
Mailing Address - Fax:
Practice Address - Street 1:4211 GARDENDALE ST STE 200A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-615-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042919225200000X
NMA-0535225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant