Provider Demographics
NPI:1508923442
Name:HEALTHCARE EXECUTIVES
Entity Type:Organization
Organization Name:HEALTHCARE EXECUTIVES
Other - Org Name:SOUTH SAN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:POTTENGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-921-1599
Mailing Address - Street 1:1007 POTEET JOURDANTON FWY STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1274
Mailing Address - Country:US
Mailing Address - Phone:210-921-1599
Mailing Address - Fax:210-921-2088
Practice Address - Street 1:1007 POTEET JOURDANTON FWY STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1274
Practice Address - Country:US
Practice Address - Phone:210-921-1599
Practice Address - Fax:210-921-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0098MROtherBLUECROSS BLUESHIELD
TX0098MROtherBLUECROSS BLUESHIELD