Provider Demographics
NPI:1871075903
Name:ALONZO, DAVID A
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ALONZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 JOHN D RYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3527
Mailing Address - Country:US
Mailing Address - Phone:210-568-3415
Mailing Address - Fax:210-677-0551
Practice Address - Street 1:5100 JOHN D RYAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3527
Practice Address - Country:US
Practice Address - Phone:210-568-3415
Practice Address - Fax:210-677-0551
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant