Healthcare Provider Details

I. General information

NPI: 1477479897
Provider Name (Legal Business Name): BLUE ZONE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 PAT BOOKER RD SUITE 5216
UNIVERSAL CITY TX
78148
US

IV. Provider business mailing address

232 BRITE RD STE 109
CIBOLO TX
78108-3997
US

V. Phone/Fax

Practice location:
  • Phone: 210-960-6952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN CLARK
Title or Position: OWNER
Credential:
Phone: 210-960-6952