MEDICARE: BLANCA DEL RIO ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1134895873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA DEL RIO ATC

Provider Business Mailing Address
First Line	:	1150 N LOOP 1604 W STE 108
Second Line	:	SUITE 108
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-4504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5103 DAVID EDWARDS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-6939
Country	:	US
Telephone Number	:	210-619-6159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	02/16/2026

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Directions to “ BLANCA DEL RIO ATC” Practice Location

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