Provider Demographics
NPI:1093191561
Name:CASTANEDA, MARTIN VICENTE ANTONIO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:VICENTE ANTONIO
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 THOUSAND OAKS DR
Mailing Address - Street 2:STE 117
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3966
Mailing Address - Country:US
Mailing Address - Phone:210-403-2871
Mailing Address - Fax:210-490-5921
Practice Address - Street 1:2235 THOUSAND OAKS DR
Practice Address - Street 2:STE 117
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3966
Practice Address - Country:US
Practice Address - Phone:210-403-2871
Practice Address - Fax:210-490-5921
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1262240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist