Provider Demographics
NPI:1689886566
Name:ORTHOPEDIC PT CENTERS LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC PT CENTERS LLC
Other - Org Name:ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-481-7730
Mailing Address - Street 1:9150 HUEBNER RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-481-7730
Mailing Address - Fax:210-481-7731
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-481-7730
Practice Address - Fax:210-481-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
TX6242080001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074PQOtherBCBS
TX191600901Medicaid
TXD06318OtherMEDICARE RAILROAD
TX0074PQOtherBCBS
TXD06318OtherMEDICARE RAILROAD