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General NPI Number Information
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NPI Number | 1528682168
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Entity Type | Organization
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Legal Business Name | DIADEM PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 403 HEIMER RD APT 514
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4891
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Country | US
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Telephone | 210-541-2077
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Fax | 210-437-3103
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Provider Business Mailing Address
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Address Line | PO BOX 701135
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City | SAN ANTONIO
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State | TX
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Zip | 78270-1135
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Country | US
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Telephone | 210-541-2077
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Fax | 210-437-3103
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Authorized Official
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Title or Position | PT
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Name | AMBER MARIE DRABEK
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Credential | PT
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Telephone | 210-440-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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