Provider Demographics
NPI:1467673608
Name:LONG BALL LTD
Entity Type:Organization
Organization Name:LONG BALL LTD
Other - Org Name:PALESTRA REHABILITATION & SPORTS TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-805-9595
Mailing Address - Street 1:1779 NE LOOP 410
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5212
Mailing Address - Country:US
Mailing Address - Phone:210-829-7979
Mailing Address - Fax:210-829-7979
Practice Address - Street 1:1779 NE LOOP 410
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5212
Practice Address - Country:US
Practice Address - Phone:210-829-7979
Practice Address - Fax:210-829-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U28XOtherOTHER INS. GROUP NUMBER
TX00637UMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER