Basic Information
| Provider Information | |||||||||
| NPI: | 1316184906 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS PHYSICAL THERAPY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8930 FOUR WINDS DR | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782391970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885904002 | ||||||||
| FaxNumber: | 2105904585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3453 N IH 35 | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102280215 | ||||||||
| FaxNumber: | 2102280223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2009 | ||||||||
| LastUpdateDate: | 01/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8306257310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 654940006 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.