Healthcare Provider Details

I. General information

NPI: 1295952091
Provider Name (Legal Business Name): JUAN G NUNEZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8632 FREDERICKSBURG RD STE 212
SAN ANTONIO TX
78240-1266
US

IV. Provider business mailing address

430 GRAPELAND DR
SAN ANTONIO TX
78264-3744
US

V. Phone/Fax

Practice location:
  • Phone: 210-696-5777
  • Fax:
Mailing address:
  • Phone: 210-626-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2003216
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: