Basic Information
| Provider Information | |||||||||
| NPI: | 1912104936 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEXAS PHYSICAL THERAPY SPECIALISTS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TEXAS PHYSICAL THERAPY SPECIALISTS SAN MARCOS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 2550 HUNTER RD | ||||||||
| Address2: | SUITE 1104 | ||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786665263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123965122 | ||||||||
| FaxNumber: | 5123965123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8306257310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 261QP2000X | 654940004 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.