Provider Demographics
NPI:1902403371
Name:VASQUEZ, THERESA CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:CHRISTINE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 TENGYC BOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1891
Mailing Address - Country:US
Mailing Address - Phone:210-744-9793
Mailing Address - Fax:
Practice Address - Street 1:2807 TENGYC BOW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1891
Practice Address - Country:US
Practice Address - Phone:210-744-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2057700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant