MEDICARE: ALTA VISTA HEALTHCARE CENTER

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	101YP2500X	Professional Counselor	15980	TX
2	225100000X	Physical Therapist	1038107	TX

General Provider Information

NPI Number	:	1366588444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA VISTA HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 600324
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75360-0324
Country	:	US
Telephone Number	:	210-822-6323
Fax Number	:	210-822-6356

Provider Business Practice Location Address
First Line	:	1123 N MAIN AVE
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4740
Country	:	US
Telephone Number	:	210-822-6323
Fax Number	:	210-822-6356

Authorized Official
Title or Position	:	COOWNER
Name	:	PHIL BOHART
Credential	:
Telephone Number	:	210-822-6323

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/11/2025

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Directions to “ALTA VISTA HEALTHCARE CENTER ” Practice Location

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