Healthcare Provider Details

I. General information

NPI: 1457657314
Provider Name (Legal Business Name): PINNACLE SPORTS PERFORMANCE & REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BEARDSLEY LN BLDG B
AUSTIN TX
78746-4945
US

IV. Provider business mailing address

300 BEARDSLEY LN BLDG B
AUSTIN TX
78746-4945
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-5500
  • Fax: 512-329-0170
Mailing address:
  • Phone: 512-329-5500
  • Fax: 512-329-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number05944
License Number StateTX

VIII. Authorized Official

Name: MAYANK A BHATT
Title or Position: OWNER
Credential: DC
Phone: 512-329-5500