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NPI Code Detail

MEDICARE: AMBRA LA SHAE HOFFMAN P.T.A.

MEDICARE: AMBRA LA SHAE HOFFMAN P.T.A.
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
1225200000XPhysical Therapy Assistant2055913TX

General Provider Information

NPI Number : 1548345556
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBRA LA SHAE HOFFMAN P.T.A.
Provider Business Mailing Address
First Line : 7838 BARLITE BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78224-1364
Country : US
Telephone Number : 210-924-4400
Fax Number : 210-334-2276
Provider Business Practice Location Address
First Line : 7838 BARLITE BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78224-1364
Country : US
Telephone Number : 210-924-4400
Fax Number : 210-334-2276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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