Basic Information
| Provider Information | |||||||||
| NPI: | 1154408318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS PHYSICAL THERAPY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12508 JONES MALTSBERGER RD | ||||||||
| Address2: | 110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782474214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885904002 | ||||||||
| FaxNumber: | 2105904585 | ||||||||
| Practice Location | |||||||||
| Address1: | 5114 BALCONES WOODS DR | ||||||||
| Address2: | #306 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127948863 | ||||||||
| FaxNumber: | 5127950688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | BURRELL | ||||||||
| AuthorizedOfficialFirstName: | SHYLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTING & CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8885904002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.