Basic Information
| Provider Information | |||||||||
| NPI: | 1528394657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALERIO | ||||||||
| FirstName: | ANISSA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YNFANTE | ||||||||
| OtherFirstName: | ANISSA | ||||||||
| OtherMiddleName: | RENEE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12952 BANDERA RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HELOTES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780234689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103729600 | ||||||||
| FaxNumber: | 2103720211 | ||||||||
| Practice Location | |||||||||
| Address1: | 5441 BABCOCK RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782403993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102533888 | ||||||||
| FaxNumber: | 2102533889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2009 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1191933 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 818T78 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 211683201 | 05 | TX | MEDICAID |