Provider Demographics
NPI:1235341835
Name:ADCOCK, GERALD ROSS (PT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ROSS
Last Name:ADCOCK
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 1:1045 CENTRAL PARKWAY NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5024
Mailing Address - Country:US
Mailing Address - Phone:210-541-4500
Mailing Address - Fax:
Practice Address - Street 1:3453 IH35 NORTH SUITE 207 B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219
Practice Address - Country:US
Practice Address - Phone:210-227-8080
Practice Address - Fax:210-298-2658
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043099OtherTX LICENSE
TXTXB121108Medicare UPIN