Provider Demographics
NPI:1205699501
Name:RESENDIZ, SOFIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:RESENDIZ
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 1:210 CAROLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1903
Mailing Address - Country:US
Mailing Address - Phone:210-482-9826
Mailing Address - Fax:
Practice Address - Street 1:14207 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1252
Practice Address - Country:US
Practice Address - Phone:210-826-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1372631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist