1912104936 NPI number — TEXAS PHYSICAL THERAPY SPECIALISTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912104936 NPI number — TEXAS PHYSICAL THERAPY SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS PHYSICAL THERAPY SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912104936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8930 FOUR WINDS DR
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78239-1970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-590-4002
Provider Business Mailing Address Fax Number:
210-590-4585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 HUNTER RD
Provider Second Line Business Practice Location Address:
SUITE 1104
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-396-5122
Provider Business Practice Location Address Fax Number:
512-396-5123
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-625-7310

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 654940004 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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