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General NPI Number Information
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NPI Number | 1750461372
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Entity Type | Organization
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Legal Business Name | PYRAMID PLAZA PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 6391 DEZAVALA RD SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2143
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Country | US
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Telephone | 210-616-0629
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Fax | 210-616-0916
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Provider Business Mailing Address
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Address Line | 6391 DEZAVALA RD SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2143
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Country | US
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Telephone | 210-616-0629
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Fax | 210-616-0916
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. MARY LEE PRATT
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Credential | P.T.
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Telephone | 210-616-0629
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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 | 605480000
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License Number State | TX
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