Healthcare Provider Details

I. General information

NPI: 1043517071
Provider Name (Legal Business Name): SARIKABEN PRAVIN BHAKTA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 HUNTER RD SUITE 1104
SAN MARCOS TX
78666-5263
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD 110
SAN ANTONIO TX
78247-4214
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-5122
  • Fax: 512-396-5123
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1203453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: