Basic Information
Provider Information
NPI: 1003000548
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARANDA
FirstName: PHILIP
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1779 NACOGDOCHES RD APT 122
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782092709
CountryCode: US
TelephoneNumber: 2107447482
FaxNumber:  
Practice Location
Address1: 855 E BASSE RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782091890
CountryCode: US
TelephoneNumber: 2108246280
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 08/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X2023620TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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