Provider Demographics
NPI:1164634101
Name:PATH TO WELLNESS
Entity Type:Organization
Organization Name:PATH TO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, RMT
Authorized Official - Phone:210-381-0044
Mailing Address - Street 1:1550 NE LOOP 410
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1610
Mailing Address - Country:US
Mailing Address - Phone:210-381-0044
Mailing Address - Fax:210-822-8263
Practice Address - Street 1:1550 NE LOOP 410
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1610
Practice Address - Country:US
Practice Address - Phone:210-381-0044
Practice Address - Fax:210-822-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051JZOtherBCBS
TX0051JZOtherBCBS