Provider Demographics
NPI:1609124312
Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Entity Type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Other - Org Name:CENTER FOR PHYSICAL THERAPY & SPORTS PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-699-8326
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1679
Mailing Address - Country:US
Mailing Address - Phone:210-699-8326
Mailing Address - Fax:210-561-7121
Practice Address - Street 1:5917 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5235
Practice Address - Country:US
Practice Address - Phone:210-253-3450
Practice Address - Fax:210-477-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164423902Medicaid
TX0051KVOtherBCBS
TXDA7604Medicare PIN
TX164423902Medicaid