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General NPI Number Information
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NPI Number | 1841528130
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Entity Type | Organization
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Legal Business Name | WATERFALLS MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 111 W ANDERSON LN SUITE D217 A
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City | AUSTIN
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State | TX
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Zip | 78752-1132
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Country | US
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Telephone | 512-420-8195
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W ANDERSON LN SUITE D217 A
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City | AUSTIN
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State | TX
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Zip | 78752-1132
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Country | US
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Telephone | 512-420-8195
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GLENDA MARITZA QUINTEROZ
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Credential |
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Telephone | 512-300-6213
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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 | 6180
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License Number State | TX
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