Provider Demographics
NPI:1003784893
Name:FONSECA-SIMOKAT, ELBA INES (PT)
Entity type:Individual
Prefix:
First Name:ELBA
Middle Name:INES
Last Name:FONSECA-SIMOKAT
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 1:521 LAKE LIVINGSTON TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3347
Mailing Address - Country:US
Mailing Address - Phone:972-632-9290
Mailing Address - Fax:
Practice Address - Street 1:3325 PATE WAY
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-8459
Practice Address - Country:US
Practice Address - Phone:972-838-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty