MEDICARE: KEVIN RADA

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	2146887	TX

General Provider Information

NPI Number	:	1760024566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RADA

Provider Business Mailing Address
First Line	:	136 JUNIPER ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4406
Country	:	US
Telephone Number	:	210-343-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 JUNIPER ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4406
Country	:	US
Telephone Number	:	210-343-9338
Fax Number	:

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

Provider Enumeration Date	:	10/13/2019
Last Update Date	:	10/13/2019

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Directions to “ KEVIN RADA ” Practice Location

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