Healthcare Provider Details

I. General information

NPI: 1316524390
Provider Name (Legal Business Name): MARY ELIZABETH MOSBACKER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W NOTTINGHAM DR
SAN ANTONIO TX
78209-1887
US

IV. Provider business mailing address

311 W NOTTINGHAM DR
SAN ANTONIO TX
78209-1887
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-2314
  • Fax:
Mailing address:
  • Phone: 210-824-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1101194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: