Provider Demographics
| NPI: | 1821107467 |
|---|---|
| Name: | NEUROPERFORMANCE PHYSICAL THERAPY, LLC |
| Entity Type: | Organization |
| Organization Name: | NEUROPERFORMANCE PHYSICAL THERAPY, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | NITO |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | BLOCHLINGER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 210-454-7992 |
| Mailing Address - Street 1: | 5310 JACKWOOD DR |
| Mailing Address - Street 2: | SUITE #2 |
| Mailing Address - City: | SAN ANTONIO |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78238-1801 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 210-256-0700 |
| Mailing Address - Fax: | 210-256-0702 |
| Practice Address - Street 1: | 5310 JACKWOOD DR |
| Practice Address - Street 2: | SUITE #2 |
| Practice Address - City: | SAN ANTONIO |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78238-1801 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 210-256-0700 |
| Practice Address - Fax: | 210-256-0702 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-29 |
| Last Update Date: | 2019-01-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 021743201 | Medicaid | |
| TX | 021743201 | Medicaid |
