Provider Demographics
NPI:1245475870
Name:ELIZONDO, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23225 KINGSLAND BLVD STE 600
Mailing Address - Street 2:SUITE 600
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3705
Mailing Address - Country:US
Mailing Address - Phone:281-395-9090
Mailing Address - Fax:
Practice Address - Street 1:23225 KINGSLAND BLVD STE 600
Practice Address - Street 2:SUITE 600
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3705
Practice Address - Country:US
Practice Address - Phone:281-395-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist