Healthcare Provider Details

I. General information

NPI: 1689885162
Provider Name (Legal Business Name): SAN ANTONIO SPINE & REHABILITATION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 SE MILITARY DR STE 107
SAN ANTONIO TX
78214-2800
US

IV. Provider business mailing address

1313 SE MILITARY DR STE 107
SAN ANTONIO TX
78214-2800
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-4884
  • Fax: 210-921-0398
Mailing address:
  • Phone: 210-924-4884
  • Fax: 210-921-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN M RAIMONDO
Title or Position: CLINIC OWNER
Credential: D.C.
Phone: 210-924-4884