Provider Demographics
NPI:1285379925
Name:CARDENAS-PEREZ, ELIZABETH (PTA)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:CARDENAS-PEREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17351 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-8029
Mailing Address - Country:US
Mailing Address - Phone:806-665-9947
Mailing Address - Fax:
Practice Address - Street 1:1619 S KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2239
Practice Address - Country:US
Practice Address - Phone:806-646-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2157862225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant