Provider Demographics
NPI:1932436227
Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO
Entity Type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-699-8329
Mailing Address - Street 1:21 SPURS LN STE 340
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1680
Mailing Address - Country:US
Mailing Address - Phone:210-798-8585
Mailing Address - Fax:210-798-8580
Practice Address - Street 1:21 SPURS LN STE 340
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1680
Practice Address - Country:US
Practice Address - Phone:210-798-8585
Practice Address - Fax:210-798-8580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-09
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11693872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty