Provider Demographics
NPI:1003140831
Name:BOERNE SPECTRUM PHYSICAL THERAPY CLINIC
Entity Type:Organization
Organization Name:BOERNE SPECTRUM PHYSICAL THERAPY CLINIC
Other - Org Name:SPECTRUM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:830-331-9443
Mailing Address - Street 1:264 HORSE HL
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1963
Mailing Address - Country:US
Mailing Address - Phone:830-331-9443
Mailing Address - Fax:
Practice Address - Street 1:264 HORSE HL
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1963
Practice Address - Country:US
Practice Address - Phone:830-331-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164493261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy