Healthcare Provider Details

I. General information

NPI: 1881070753
Provider Name (Legal Business Name): HILL COUNTRY ELECTRODIAGNOSTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E SONTERRA BLVD 211
SAN ANTONIO TX
78258-3987
US

IV. Provider business mailing address

120 BREEZE WAY
BOERNE TX
78006-5008
US

V. Phone/Fax

Practice location:
  • Phone: 830-446-1410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1160740
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number1160740
License Number StateTX

VIII. Authorized Official

Name: GREGORY P ERNST
Title or Position: PROVIDER
Credential: M.P.T.
Phone: 830-446-1410