Organization
ELATA HEALTH AND WELLNESS, LLC
Active
Other names
Active Life Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CATHERINE YAZON CUSTODIO PT (PT/OWNER)
(972) 984-7670
Entity
Organization
Contact information
Practice address
2600 ELDORADO PKWY STE 130, MCKINNEY, TX 75070-7517
(972) 984-7670
(972) 984-7671
Mailing address
2600 ELDORADO PKWY STE 130, MCKINNEY, TX 75070-7517
(972) 984-7670
(972) 984-7671
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
04/09/2016
Last updated
10/14/2022
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