Provider Demographics
NPI:1891817714
Name:NEW BRAUNFELS SPORTS & SPINE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NEW BRAUNFELS SPORTS & SPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-620-4922
Mailing Address - Street 1:1744 E COMMON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6079
Mailing Address - Country:US
Mailing Address - Phone:830-620-4922
Mailing Address - Fax:830-625-1194
Practice Address - Street 1:1744 E COMMON ST STE 400
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6079
Practice Address - Country:US
Practice Address - Phone:830-620-4922
Practice Address - Fax:830-625-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660870000225100000X
TX556150000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073PKOtherBLUE CROSS BLUE SHIELD
TX00Z439Medicare PIN