Healthcare Provider Details

I. General information

NPI: 1326672296
Provider Name (Legal Business Name): TRICITY PAIN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28255 INTERSTATE 10 W STE 103
BOERNE TX
78006-6508
US

IV. Provider business mailing address

19141 STONE OAK PKWY STE 104
SAN ANTONIO TX
78258-3367
US

V. Phone/Fax

Practice location:
  • Phone: 830-755-5223
  • Fax: 833-841-7131
Mailing address:
  • Phone: 210-268-0129
  • Fax: 210-314-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: URFAN AHMAD DAR
Title or Position: CEO
Credential: MD
Phone: 210-268-0129