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General NPI Number Information
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NPI Number | 1245754357
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Entity Type | Organization
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Legal Business Name | PM&R ASSOCIATES OF SAN ANTONIO PLLC
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 17503 LA CANTERA PKWY STE 104-456
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City | SAN ANTONIO
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State | TX
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Zip | 78257-8207
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Country | US
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Telephone | 210-571-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 17503 LA CANTERA PKWY STE 104-456
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City | SAN ANTONIO
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State | TX
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Zip | 78257-8207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN DENNIS CAYANAN ALFONSO
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Credential |
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Telephone | 210-571-7100
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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 | P4538
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License Number State | TX
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