Individual
ELISA G VIDAURRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
415 EMBASSY OAKS, 202, SAN ANTONIO, TX 78216-2040
(210) 490-4738
(210) 490-5231
Mailing address
415 EMBASSY OAKS, 202, SAN ANTONIO, TX 78216-2040
(210) 490-4738
(210) 490-5231
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1132140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1132140
LICENSE NUMBER
TX
01
—
7981357
AETNA
TX
Enumeration date
06/04/2006
Last updated
06/05/2013
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