MEDICARE: SOUTH TEXAS SPORTS MEDICINE INC

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	261QP2000X	Physical Therapy Clinic/Center	604380000	TX
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1356660369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS SPORTS MEDICINE INC

Provider Business Mailing Address
First Line	:	203 CEDAR DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2900
Country	:	US
Telephone Number	:	361-993-9494
Fax Number	:	361-993-4477

Provider Business Practice Location Address
First Line	:	5530 LIPES BLVD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-5511
Country	:	US
Telephone Number	:	361-993-9494
Fax Number	:	361-687-2464

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD RAY ZYLKS
Credential	:	PHD
Telephone Number	:	361-728-4288

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	03/23/2026

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Directions to “SOUTH TEXAS SPORTS MEDICINE INC ” Practice Location

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