Provider Demographics
NPI:1750497640
Name:PHYSICAL THERAPY PROVIDERS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BLEDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:210-593-0578
Mailing Address - Street 1:800 ISOM RD
Mailing Address - Street 2:#106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-366-1733
Mailing Address - Fax:210-366-1799
Practice Address - Street 1:109 SOUTH HASLER ROAD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:210-366-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty