Provider Demographics
NPI:1093806820
Name:KERESZTES, MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KERESZTES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 N WALNUT AVE
Mailing Address - Street 2:STE 47
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6045
Mailing Address - Country:US
Mailing Address - Phone:830-358-1151
Mailing Address - Fax:830-626-3422
Practice Address - Street 1:1551 N WALNUT AVE
Practice Address - Street 2:STE 47
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6045
Practice Address - Country:US
Practice Address - Phone:830-358-1151
Practice Address - Fax:830-626-3422
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1173313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200397770Medicaid
IN000000178956OtherANTHEM