Healthcare Provider Details

I. General information

NPI: 1821604786
Provider Name (Legal Business Name): ABEL AZIZ ESCAMILLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 BLANCO RD
SAN ANTONIO TX
78232-1902
US

IV. Provider business mailing address

8050 OAKDELL WAY APT 908
SAN ANTONIO TX
78240-3914
US

V. Phone/Fax

Practice location:
  • Phone: 210-572-4954
  • Fax:
Mailing address:
  • Phone: 830-719-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2154896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: