MEDICARE: MR. JUAN G NUNEZ PTA

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	225200000X	Physical Therapy Assistant	2003216	TX

General Provider Information

NPI Number	:	1295952091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN G NUNEZ PTA

Provider Business Mailing Address
First Line	:	430 GRAPELAND DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78264-3744
Country	:	US
Telephone Number	:	210-626-0126
Fax Number	:

Provider Business Practice Location Address
First Line	:	8632 FREDERICKSBURG RD STE 212
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1266
Country	:	US
Telephone Number	:	210-696-5777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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