Healthcare Provider Details

I. General information

NPI: 1174865984
Provider Name (Legal Business Name): CONCENTRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 BROADWAY ST SUITE 201
SAN ANTONIO TX
78217-4431
US

IV. Provider business mailing address

10200 BROADWAY ST SUITE 201
SAN ANTONIO TX
78217-4431
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-8787
  • Fax:
Mailing address:
  • Phone: 210-654-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number211696
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID E MASSING
Title or Position: AREA THERAPY DIRECTOR
Credential: MPT
Phone: 210-569-2153