Healthcare Provider Details

I. General information

NPI: 1417951237
Provider Name (Legal Business Name): SAN ANTONIO ORTHOTICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 LOUIS PASTEUR STE 144
SAN ANTONIO TX
78229-4535
US

IV. Provider business mailing address

7220 LOUIS PASTEUR STE 144
SAN ANTONIO TX
78229-4535
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8777
  • Fax: 210-614-8795
Mailing address:
  • Phone: 210-614-8777
  • Fax: 210-614-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000153
License Number StateTX

VIII. Authorized Official

Name: MR. FRANK DANIEL MARTINEZ
Title or Position: ORTHOTIST/OWNER
Credential: LO,BOCO,C.O
Phone: 210-614-8777