Provider Demographics
NPI:1043038391
Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Entity type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-756-5240
Mailing Address - Street 1:PO BOX 268996
Mailing Address - Street 2:DEPT 1131
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:210-699-8326
Mailing Address - Fax:
Practice Address - Street 1:10622 STATE HIGHWAY 151 STE 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4729
Practice Address - Country:US
Practice Address - Phone:210-798-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies