Provider Demographics
NPI:1841527520
Name:ELIANO, ASHLEY REGENIA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REGENIA
Last Name:ELIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD
Mailing Address - Street 2:#260
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3202
Mailing Address - Country:US
Mailing Address - Phone:210-656-7953
Mailing Address - Fax:210-656-7957
Practice Address - Street 1:12413 JUDSON RD
Practice Address - Street 2:#260
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3202
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:210-656-7957
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1204990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist