MEDICARE: STRATTON 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	174400000X	Specialist	1030005	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	369496	OTHER	TX	OPT-OUT OF MEDICARE, OUT OF NETWORK PROVIDER

General Provider Information

NPI Number	:	1164957684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATTON PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	818 KNIGHTS CROSS DR
Second Line	:	SUITE #5107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2982
Country	:	US
Telephone Number	:	210-612-7952
Fax Number	:	855-492-1012

Provider Business Practice Location Address
First Line	:	818 KNIGHTS CROSS DR
Second Line	:	SUITE #5107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2982
Country	:	US
Telephone Number	:	210-612-7952
Fax Number	:	855-492-1012

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEVEN ALDEN STRATTON
Credential	:	PT
Telephone Number	:	210-612-7952

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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Directions to “STRATTON PHYSICAL THERAPY ” Practice Location

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