Healthcare Provider Details

I. General information

NPI: 1356645311
Provider Name (Legal Business Name): NICHOLAS JEFFREY BRANCH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 PAESANOS PKWY STE 101
SAN ANTONIO TX
78231-1225
US

IV. Provider business mailing address

3503 PAESANOS PKWY STE 101
SAN ANTONIO TX
78231-1225
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-8922
  • Fax: 210-479-2010
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: