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General NPI Number Information
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NPI Number | 1093161457
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Entity Type | Organization
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Legal Business Name | THE CONCUSSION CENTER LLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 2040 BABCOCK RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4425
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Country | US
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Telephone | 210-692-7070
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Fax | 210-692-7079
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Provider Business Mailing Address
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Address Line | 2040 BABCOCK RD STE 303
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4428
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Country | US
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Telephone | 210-375-6697
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Fax | 210-375-6396
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Authorized Official
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Title or Position | MANAGER
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Name | RICHARD A EVANS
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Credential | DPT
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Telephone | 210-692-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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