Provider Demographics
NPI:1922087378
Name:PT HOME SERVICES OF SAN ANTONIO INC
Entity Type:Organization
Organization Name:PT HOME SERVICES OF SAN ANTONIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-468-4747
Mailing Address - Street 1:40 N E LOOP 410
Mailing Address - Street 2:SUITE # 640
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5827
Mailing Address - Country:US
Mailing Address - Phone:210-342-2667
Mailing Address - Fax:210-340-2416
Practice Address - Street 1:40 NE LOOP 410
Practice Address - Street 2:#640
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5828
Practice Address - Country:US
Practice Address - Phone:210-342-2667
Practice Address - Fax:210-340-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003402251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002357Medicaid
TX678016Medicare Oscar/Certification