Provider Demographics
NPI:1790939536
Name:SAN MARCOS PT SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:SAN MARCOS PT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:512-396-5122
Mailing Address - Street 1:2550 HUNTER RD STE 1104
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5109
Mailing Address - Country:US
Mailing Address - Phone:512-396-5122
Mailing Address - Fax:512-396-5123
Practice Address - Street 1:8930 FOUR WINDS DR
Practice Address - Street 2:109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-1970
Practice Address - Country:US
Practice Address - Phone:888-590-4002
Practice Address - Fax:210-590-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5841111NN1001X
TX1173060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty