Provider Demographics
NPI:1104635036
Name:HELTON-ILIRIA, ADDISON LELA (MAT, LAT,ATC)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:LELA
Last Name:HELTON-ILIRIA
Suffix:
Gender:F
Credentials:MAT, LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 OWNBY DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:619-884-3530
Mailing Address - Fax:214-768-1225
Practice Address - Street 1:5800 OWNBY DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:619-884-3530
Practice Address - Fax:214-768-1225
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT97592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer