Provider Demographics
NPI:1538517057
Name:HEALTHCARE EXECUTIVES
Entity Type:Organization
Organization Name:HEALTHCARE EXECUTIVES
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTERS SOUTH SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:POTTENGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-921-1599
Mailing Address - Street 1:2406 COMMERCIAL AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1757
Mailing Address - Country:US
Mailing Address - Phone:210-921-1599
Mailing Address - Fax:210-921-2088
Practice Address - Street 1:2406 COMMERCIAL AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1757
Practice Address - Country:US
Practice Address - Phone:210-921-1599
Practice Address - Fax:210-921-2088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE EXECUTIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4505OtherBLUECROSS BLUESHIELD
TX188942001Medicaid
TX188942001Medicaid