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Organization
THE ORTHOPEDIC STORE
Active
Organization
THE ORTHOPEDIC STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN RANDOLPH HARIG (PRESIDENT/OWNER)
(210) 366-2990
Entity
Organization
Contact information
Practice address
1211 ARION PKWY, SUITE 100, SAN ANTONIO, TX 78216-2808
(210) 366-2990
(210) 499-4984
Mailing address
PO BOX 792590, SAN ANTONIO, TX 78279-2590
(210) 366-2990
(210) 499-4984
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
643020000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040GZ
BCBS OF TEXAS-PT
TX
05
—
1446627-01
—
TX
05
—
1446635-01
—
TX
01
—
643020000
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
TX
Enumeration date
06/16/2005
Last updated
10/14/2009
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