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General NPI Number Information
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NPI Number | 1235160250
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS SPORTS MEDICINE INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 203 CEDAR DR
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City | PORTLAND
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State | TX
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Zip | 78374-2900
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Country | US
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Telephone | 361-643-3993
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Fax | 361-687-2465
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Provider Business Mailing Address
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Address Line | 5530 LIPES BLVD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-5511
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Country | US
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Telephone | 361-993-9494
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Fax | 361-993-4477
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD R ZYLKS
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Credential | PH.D
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Telephone | 361-728-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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