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General NPI Number Information
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NPI Number | 1285160853
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Entity Type | Organization
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Legal Business Name | CRYO BODY SHAPE
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 7219 GLEN ELLEN BAY
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1757
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Country | US
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Telephone | 281-684-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 7219 GLEN ELLEN BAY
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1757
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Country | US
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Telephone | 281-684-5412
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Fax |
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Authorized Official
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Title or Position | CHIEF NURSE
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Name | DIANA HORTON
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Credential | REGISTERED NURSE RN
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Telephone | 281-684-5412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 637553
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 637553
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 637553
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License Number State | TX
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