Provider Demographics
NPI:1215050786
Name:VEGA, GRAIELA LUNA (PT)
Entity type:Individual
Prefix:
First Name:GRAIELA
Middle Name:LUNA
Last Name:VEGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19334 SHILOH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5066
Mailing Address - Country:US
Mailing Address - Phone:832-868-7445
Mailing Address - Fax:
Practice Address - Street 1:19334 SHILOH CREEK LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5066
Practice Address - Country:US
Practice Address - Phone:832-868-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist