Healthcare Provider Details

I. General information

NPI: 1770090250
Provider Name (Legal Business Name): MICHELLE PINEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAM CANNON DR STE 225
AUSTIN TX
78745-6644
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE 110
SAN ANTONIO TX
78247-4215
US

V. Phone/Fax

Practice location:
  • Phone: 512-270-2060
  • Fax: 512-270-2061
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1300190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: