Maria Catherine Yazon Custodio, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1152640 Issued in TX

Practice address

2600 Eldorado Pkwy Ste 130
McKinney, TX 75070-7517

Phone

(972) 984-7670

Fax

(972) 984-7671

NPI assigned

Nov 5, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Cathy Custodio Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elata Health and Wellness, LLCGroup PAC ID 8527359652, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elata Health and Wellness, LLC

  dba Active Life Physical Therapy

  • Physical Therapist
  • McKinney, TX
  • NPI 1417311028
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1437555323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 ELDORADO PKWY STE 130",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750707517",
            "telephone_number": "972-984-7670",
            "fax_number": "972-984-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 ELDORADO PKWY STE 130",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750707517",
            "telephone_number": "972-984-7670",
            "fax_number": "972-984-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTODIO",
        "first_name": "MARIA CATHERINE",
        "middle_name": "YAZON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-05",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1152640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CATHY",
            "last_name": "CUSTODIO",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kathleen M Curran, LMHC
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• Custom Dental of McKinney, PLLC
• CVS Pharmacy Inc (CVS Pharmacy # 05799)
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• CVS Pharmacy Inc (CVS Pharmacy # 05952)
• CVS Pharmacy Inc. (CVS Pharmacy #)

• Physical Therapist in McKinney, TX
• Providers in McKinney, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.