Provider Demographics
NPI:1508425554
Name:NASH, MICHAEL LAVAUGHN (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAVAUGHN
Last Name:NASH
Suffix:
Gender:M
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 CULEBRA ROAD
Mailing Address - Street 2:BLDG. 1, SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-828-7557
Mailing Address - Fax:210-828-7756
Practice Address - Street 1:11919 CULEBRA ROAD
Practice Address - Street 2:BLDG. 1, SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253
Practice Address - Country:US
Practice Address - Phone:210-828-7757
Practice Address - Fax:210-828-7756
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3123570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist