Healthcare Provider Details

I. General information

NPI: 1659070209
Provider Name (Legal Business Name): ERIN BRASSEAUX PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

643 BRIGHTWOOD PL
SAN ANTONIO TX
78209-3454
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone: 832-729-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1365222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: