Basic Information
Provider Information
NPI: 1033705298
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VELA
FirstName: CAITLIN
MiddleName: ALEXANDRA
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 288 W BITTERS RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782161665
CountryCode: US
TelephoneNumber: 2102979906
FaxNumber:  
Practice Location
Address1: 288 W BITTERS RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782161665
CountryCode: US
TelephoneNumber: 2102979906
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/11/2020
LastUpdateDate: 12/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1322318TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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