Provider Demographics
NPI:1275398141
Name:GARY, JUANITA SANCHEZ (LMT)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:SANCHEZ
Last Name:GARY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 E HUTCHINS PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2438
Mailing Address - Country:US
Mailing Address - Phone:210-914-1388
Mailing Address - Fax:
Practice Address - Street 1:2602 PLEASANTON RD STE 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1801
Practice Address - Country:US
Practice Address - Phone:210-914-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist