Healthcare Provider Details

I. General information

NPI: 1801376637
Provider Name (Legal Business Name): MATTHEW JOSEPH KRAUS OTR, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DALLAS ST
SAN ANTONIO TX
78205-1201
US

IV. Provider business mailing address

515 MARQUIS LN
SAN ANTONIO TX
78216-5217
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-7000
  • Fax:
Mailing address:
  • Phone: 210-533-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number106473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: