Provider Demographics
NPI:1164604575
Name:BOERNE PHYSICAL THERAPY INSTITUTE
Entity Type:Organization
Organization Name:BOERNE PHYSICAL THERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:KASPROWICZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:830-249-7211
Mailing Address - Street 1:430 W BANDERA RD
Mailing Address - Street 2:#9
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2500
Mailing Address - Country:US
Mailing Address - Phone:830-249-7211
Mailing Address - Fax:830-249-4698
Practice Address - Street 1:430 W BANDERA RD
Practice Address - Street 2:#9
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2500
Practice Address - Country:US
Practice Address - Phone:830-249-7211
Practice Address - Fax:830-249-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163071261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83073TOtherBLUE CROSS/BLUE SHIELD
TX00723TMedicare PIN