Provider Demographics
NPI:1619518685
Name:OUELLETTE, JOSEPH A III (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:OUELLETTE
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16737 WINDJAMMER
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3426
Mailing Address - Country:US
Mailing Address - Phone:214-601-3081
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE SAN ANTONIO, TX 78230.
Practice Address - Street 2:SUITE D-400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-7823
Practice Address - Country:US
Practice Address - Phone:210-692-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145481225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty