Healthcare Provider Details
I. General information
NPI: 1740814623
Provider Name (Legal Business Name): TRICITY PAIN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8401 DATAPOINT DR STE 401
SAN ANTONIO TX
78229-5925
US
IV. Provider business mailing address
PO BOX 4253
HOUSTON TX
77210-4253
US
V. Phone/Fax
- Phone: 210-979-7500
- Fax: 833-841-7131
- Phone: 210-268-0129
- Fax: 210-314-4609
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
URFAN
AHMAD
DAR
Title or Position: CEO
Credential: MD
Phone: 210-268-0129