Provider Demographics
NPI:1053006205
Name:SAENZ, IDA (LMT)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:SAENZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 SOUTH STAPLES CORPUS CHRISITI TX 78413
Mailing Address - Street 2:STE D4
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413
Mailing Address - Country:US
Mailing Address - Phone:361-549-1250
Mailing Address - Fax:
Practice Address - Street 1:5926 SOUTH STAPLES CORPUS CHRISITI TX 78413
Practice Address - Street 2:STE D4
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413
Practice Address - Country:US
Practice Address - Phone:361-549-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT29986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty