Provider Demographics
NPI:1043444888
Name:SAN ANTONIO PHYSICAL MEDICINE AND REHABILITATION CLINICS PA
Entity Type:Organization
Organization Name:SAN ANTONIO PHYSICAL MEDICINE AND REHABILITATION CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNUGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-366-9906
Mailing Address - Street 1:20770 US HIGHWAY 281 N
Mailing Address - Street 2:#108-492
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7519
Mailing Address - Country:US
Mailing Address - Phone:210-366-9906
Mailing Address - Fax:210-297-0731
Practice Address - Street 1:20770 US HIGHWAY 281 N
Practice Address - Street 2:#108-492
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7519
Practice Address - Country:US
Practice Address - Phone:210-366-9906
Practice Address - Fax:210-297-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2966208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040TBOtherBCBS OF TX
TX0040TBOtherBCBS OF TX