Provider Demographics
NPI:1891388757
Name:RAMIREZ, ILIANA ISABEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:ISABEL
Last Name:RAMIREZ
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 1:2511 W BRAKER LN APT 182
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-1206
Mailing Address - Country:US
Mailing Address - Phone:915-356-6015
Mailing Address - Fax:
Practice Address - Street 1:7801 N LAMAR BLVD STE B174
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1032
Practice Address - Country:US
Practice Address - Phone:512-371-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1342411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist