Organization
CRYO BODY SHAPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA HORTON REGISTERED NURSE RN (CHIEF NURSE)
(281) 684-5412
Entity
Organization
Contact information
Practice address
7219 GLEN ELLEN BAY, SAN ANTONIO, TX 78244-1757
(281) 684-5412
Mailing address
7219 GLEN ELLEN BAY, SAN ANTONIO, TX 78244-1757
(281) 684-5412
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
637553
TX
261QP3300X
Pain Clinic/Center
637553
TX
305R00000X
Preferred Provider Organization
637553
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224X000000X
—
TX
05
—
261Q0000X
—
TX
05
—
261QP2000X
—
TX
Enumeration date
05/02/2017
Last updated
05/02/2017
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