Provider Demographics
NPI:1972972701
Name:WACLAWCZYK, SANDRA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:WACLAWCZYK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:JAECKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1248 AUSTIN HWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4821
Mailing Address - Country:US
Mailing Address - Phone:210-646-8008
Mailing Address - Fax:210-646-8242
Practice Address - Street 1:1248 AUSTIN HWY
Practice Address - Street 2:STE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4821
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2013744225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant