Healthcare Provider Details

I. General information

NPI: 1720699754
Provider Name (Legal Business Name): JUAN ROBLEDO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 S NEW BRAUNFELS AVE STE 1114
SAN ANTONIO TX
78223-4588
US

IV. Provider business mailing address

8627 CINNAMON CREEK DR STE 402
SAN ANTONIO TX
78240-1482
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-0359
  • Fax: 210-253-9355
Mailing address:
  • Phone: 210-892-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1334648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: