Healthcare Provider Details

I. General information

NPI: 1619518685
Provider Name (Legal Business Name): JOSEPH A. OUELLETTE III PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CHERRY RIDGE SAN ANTONIO, TX 78230. SUITE D-400
SAN ANTONIO TX
78230-7823
US

IV. Provider business mailing address

16737 WINDJAMMER
HELOTES TX
78023-3426
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-0222
  • Fax:
Mailing address:
  • Phone: 214-601-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2145481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: