MEDICARE: ACTIVE EVOLUTION PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1013626423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE EVOLUTION PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	12370 POTRANCO RD STE 207
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12370 POTRANCO RD STE 207
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4261
Country	:	US
Telephone Number	:	210-570-4312
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ARIELLE GARCIA
Credential	:	PT, DPT, COMT
Telephone Number	:	956-451-8204

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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Directions to “ACTIVE EVOLUTION PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

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