Provider Demographics
NPI:1295453264
Name:MERCADO, BERNABE ISAAC (PT, DPT)
Entity type:Individual
Prefix:
First Name:BERNABE
Middle Name:ISAAC
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3262
Mailing Address - Country:US
Mailing Address - Phone:210-656-7953
Mailing Address - Fax:210-656-7957
Practice Address - Street 1:3110 NOGALITOS STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-2338
Practice Address - Country:US
Practice Address - Phone:210-534-7953
Practice Address - Fax:210-534-6695
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1365532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist