MEDICARE: SAN ANTONIO ORTHOTICS

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	335E00000X	Prosthetic/Orthotic Supplier	101162	TX

General Provider Information

NPI Number	:	1801890504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO ORTHOTICS

Provider Business Mailing Address
First Line	:	18585 SIGMA RD
Second Line	:	STE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4204
Country	:	US
Telephone Number	:	210-496-9940
Fax Number	:	210-403-0571

Provider Business Practice Location Address
First Line	:	18585 SIGMA RD
Second Line	:	STE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4204
Country	:	US
Telephone Number	:	210-496-9940
Fax Number	:	210-403-0571

Authorized Official
Title or Position	:	ORTHOTIST/OWNER
Name	:	MR. JOHN DOMINGO MARTINEZ
Credential	:	LO,BOCO, C.O.
Telephone Number	:	210-496-9940

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2020

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Directions to “SAN ANTONIO ORTHOTICS ” Practice Location

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