Provider Demographics
NPI:1457041188
Name:FLORES III, ANTONIO (OTA)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:FLORES III
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 BLANCO RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7756
Mailing Address - Country:US
Mailing Address - Phone:210-479-5875
Mailing Address - Fax:
Practice Address - Street 1:13333 BLANCO RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7756
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417498224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant