Basic Information
| Provider Information | |||||||||
| NPI: | 1063079077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTHOF | ||||||||
| FirstName: | BAYLEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12508 JONES MALTSBERGER RD STE 110 | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782474215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105904000 | ||||||||
| FaxNumber: | 2105904585 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 S INTERSTATE 35 STE 203 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786284125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128637761 | ||||||||
| FaxNumber: | 5128630973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2019 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1318398 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.