Healthcare Provider Details

I. General information

NPI: 1922325430
Provider Name (Legal Business Name): LUIS A. ESCALANTE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 OAK CENTRE DR STE 450
SAN ANTONIO TX
78258-4072
US

IV. Provider business mailing address

8802 SUMMER TRL
SAN ANTONIO TX
78250-2612
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-4525
  • Fax: 210-297-0459
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1174978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: