Provider Demographics
NPI:1134367030
Name:JENDRUSCH, MATTHEW RYAN (PT, CKTP, MSPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RYAN
Last Name:JENDRUSCH
Suffix:
Gender:M
Credentials:PT, CKTP, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 BROADWAY ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6332
Mailing Address - Country:US
Mailing Address - Phone:210-828-7557
Mailing Address - Fax:210-828-7756
Practice Address - Street 1:8610 BROADWAY ST
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6332
Practice Address - Country:US
Practice Address - Phone:210-828-7557
Practice Address - Fax:210-828-7756
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist