Provider Demographics
NPI:1588199723
Name:CORESSENTIALS PHYSICAL THERAPY AND PELVIC WELLNESS
Entity Type:Organization
Organization Name:CORESSENTIALS PHYSICAL THERAPY AND PELVIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:DUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-725-3700
Mailing Address - Street 1:20330 HUEBNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3509
Mailing Address - Country:US
Mailing Address - Phone:210-725-3700
Mailing Address - Fax:
Practice Address - Street 1:20330 HUEBNER RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3509
Practice Address - Country:US
Practice Address - Phone:210-725-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092559261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385079YPW5Medicare PIN