Healthcare Provider Details

I. General information

NPI: 1285884130
Provider Name (Legal Business Name): BENT TREE BRACING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7744 BROADWAY ST STE 201
SAN ANTONIO TX
78209-3262
US

IV. Provider business mailing address

7744 BROADWAY ST STE 201
SAN ANTONIO TX
78209-3262
US

V. Phone/Fax

Practice location:
  • Phone: 210-363-7759
  • Fax:
Mailing address:
  • Phone: 210-363-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. QUANTRELL L. WASHINGTON
Title or Position: CO-OWNER
Credential: NREMT
Phone: 210-363-7759