Provider Demographics
NPI:1174865984
Name:CONCENTRA
Entity Type:Organization
Organization Name:CONCENTRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA THERAPY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MASSING
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:210-569-2153
Mailing Address - Street 1:10200 BROADWAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4431
Mailing Address - Country:US
Mailing Address - Phone:210-654-8787
Mailing Address - Fax:
Practice Address - Street 1:10200 BROADWAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4431
Practice Address - Country:US
Practice Address - Phone:210-654-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211696261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center