Provider Demographics
NPI:1750461372
Name:PYRAMID PLAZA PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PYRAMID PLAZA PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-616-0629
Mailing Address - Street 1:6391 DEZAVALA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2143
Mailing Address - Country:US
Mailing Address - Phone:210-616-0629
Mailing Address - Fax:210-616-0916
Practice Address - Street 1:6391 DEZAVALA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2143
Practice Address - Country:US
Practice Address - Phone:210-616-0629
Practice Address - Fax:210-616-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605480000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650248Medicare ID - Type Unspecified