Basic Information
| Provider Information | |||||||||
| NPI: | 1215185947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | AZALEA | ||||||||
| MiddleName: | IRIS | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3875 E SOUTHCROSS BLVD | ||||||||
| Address2: | B | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782223521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103377953 | ||||||||
| FaxNumber: | 2103377966 | ||||||||
| Practice Location | |||||||||
| Address1: | 12315 JUDSON RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782333206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106567953 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2008 | ||||||||
| LastUpdateDate: | 09/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1176878 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.