Healthcare Provider Details

I. General information

NPI: 1730102955
Provider Name (Legal Business Name): MR. DONNIE L. PELZEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-2020
  • Fax:
Mailing address:
  • Phone: 830-896-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number27514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: