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NPI Code Detail

MEDICARE: KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC

MEDICARE: KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
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
1225100000XPhysical TherapistTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10084HNOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1710290325
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Provider Business Mailing Address
First Line : 8627 CINNAMON CREEK DR
Second Line : SUITE 402
City : SAN ANTONIO
State : TX
Zip : 78240-1480
Country : US
Telephone Number : 210-695-8731
Fax Number : 210-598-0432
Provider Business Practice Location Address
First Line : 11219 POTRANCO RD
Second Line : BUILDING A #110
City : SAN ANTONIO
State : TX
Zip : 78253-5848
Country : US
Telephone Number : 210-679-6900
Fax Number : 210-679-6904
Authorized Official
Title or Position : CHARIMAN OF THE BOARD
Name : MR. CHAD A ELMS
Credential : PT
Telephone Number : 210-372-9600
Provider Enumeration Date : 07/23/2010
Last Update Date : 11/27/2013

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1720122682 — MRS. ELIZABETH ANNE MENCHACA P.T.
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Practice Location Address:
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Directions to “KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC ” Practice Location

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