MEDICARE: WEISS NEURO THERAPY & WELLNESS

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	261QH0100X	Health Service Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1356606297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEISS NEURO THERAPY & WELLNESS

Provider Business Mailing Address
First Line	:	1542 BENTON WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 BENTON WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4494
Country	:	US
Telephone Number	:	210-573-1386
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DEBORAH SUZANNE WEISS
Credential	:	BA, MPT, MSCS
Telephone Number	:	210-573-1386

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/10/2012

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