Healthcare Provider Details

I. General information

NPI: 1104007046
Provider Name (Legal Business Name): ANTHONY PAUL FLESURAS ATC, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18945 FM 2252
GARDEN RIDGE TX
78266
US

IV. Provider business mailing address

18945 FM 2252 STE 115
GARDEN RIDGE TX
78266-2797
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0027
  • Fax: 210-651-0029
Mailing address:
  • Phone: 866-595-6379
  • Fax: 210-651-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: