Healthcare Provider Details

I. General information

NPI: 1225287006
Provider Name (Legal Business Name): MATTER IN MOTION PHYSICAL REHABILITATION, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SOUTHBRIDGE ST
SAN ANTONIO TX
78216-6229
US

IV. Provider business mailing address

117 SOUTHBRIDGE ST
SAN ANTONIO TX
78216-6229
US

V. Phone/Fax

Practice location:
  • Phone: 210-858-8500
  • Fax: 210-599-8853
Mailing address:
  • Phone: 210-858-8500
  • Fax: 210-599-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberK9153
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHANIE PRADO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 210-858-8500