Provider Demographics
NPI:1922249473
Name:OSBORNE, MICHAEL R JR (LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:OSBORNE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 690665
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0665
Mailing Address - Country:US
Mailing Address - Phone:210-723-6723
Mailing Address - Fax:210-699-0005
Practice Address - Street 1:503 S MAIN
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1207
Practice Address - Country:US
Practice Address - Phone:210-723-6723
Practice Address - Fax:210-699-0005
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT 018858225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist