Healthcare Provider Details

I. General information

NPI: 1174061337
Provider Name (Legal Business Name): TEXAS PHYSICAL THERAPY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 HUEBNER RD
SAN ANTONIO TX
78240-1693
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD 110
SAN ANTONIO TX
78247-4214
US

V. Phone/Fax

Practice location:
  • Phone: 210-714-5810
  • Fax: 210-714-5811
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number654940029
License Number StateTX

VIII. Authorized Official

Name: SHYLA BURRELL
Title or Position: CONTRACTING & CREDENTIALING MANAGER
Credential:
Phone: 888-590-4002