Provider Demographics
NPI:1629210760
Name:NEW BRAUNFELS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:NEW BRAUNFELS PHYSICAL THERAPY INC
Other - Org Name:COMPREHENSIVE CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-545-1810
Mailing Address - Street 1:930 PROTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4231
Mailing Address - Country:US
Mailing Address - Phone:210-545-1810
Mailing Address - Fax:210-545-1811
Practice Address - Street 1:930 PROTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4231
Practice Address - Country:US
Practice Address - Phone:210-545-1810
Practice Address - Fax:210-545-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty