Provider Demographics
NPI:1689885162
Name:SAN ANTONIO SPINE & REHABILITATION, P.A.
Entity Type:Organization
Organization Name:SAN ANTONIO SPINE & REHABILITATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAIMONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-924-4884
Mailing Address - Street 1:1313 SE MILITARY DR
Mailing Address - Street 2:STE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2800
Mailing Address - Country:US
Mailing Address - Phone:210-924-4884
Mailing Address - Fax:210-921-0398
Practice Address - Street 1:1313 SE MILITARY DR
Practice Address - Street 2:STE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2800
Practice Address - Country:US
Practice Address - Phone:210-924-4884
Practice Address - Fax:210-921-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation