Healthcare Provider Details

I. General information

NPI: 1487134615
Provider Name (Legal Business Name): MARIA JANETTE ODEJAR BAKING PT, DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E SONTERRA BLVD
SAN ANTONIO TX
78258-4347
US

IV. Provider business mailing address

28831 THROSSEL LN
SAN ANTONIO TX
78260-4463
US

V. Phone/Fax

Practice location:
  • Phone: 407-547-5168
  • Fax:
Mailing address:
  • Phone: 407-547-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1216387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: