MEDICARE: DR. GREGORY PAUL ERNST PT

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	2251E1300X	Clinical Electrophysiology Physical Therapist	1160740	TX

General Provider Information

NPI Number	:	1669452454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PAUL ERNST PT

Provider Business Mailing Address
First Line	:	120 BREEZE WAY
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-5008
Country	:	US
Telephone Number	:	830-537-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 E SONTERRA BLVD STE 211
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3989
Country	:	US
Telephone Number	:	210-494-9600
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	06/26/2015

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