Provider Demographics
NPI:1801378203
Name:GREENWOOD, CARL KEITH JR
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:KEITH
Last Name:GREENWOOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARLANDITT
Other - Middle Name:KEITH
Other - Last Name:GREENWOOD
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:6211 S NEW BRAUNFELS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3175
Mailing Address - Country:US
Mailing Address - Phone:210-531-0569
Mailing Address - Fax:
Practice Address - Street 1:6211 S NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3175
Practice Address - Country:US
Practice Address - Phone:210-531-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant