Provider Demographics
NPI:1063874725
Name:PLASENCIA FAULKS, NAHYELI (PT, DPT)
Entity type:Individual
Prefix:
First Name:NAHYELI
Middle Name:
Last Name:PLASENCIA FAULKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NAHYELI
Other - Middle Name:
Other - Last Name:PLASENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2519 S LAKELINE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2964
Mailing Address - Country:US
Mailing Address - Phone:512-331-6200
Mailing Address - Fax:512-331-6384
Practice Address - Street 1:2519 S LAKELINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2964
Practice Address - Country:US
Practice Address - Phone:512-331-6200
Practice Address - Fax:512-331-6384
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist