Organization
AMISTAD PHYSICAL THERAPY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE ALSUP P.T. (OWNER/PHYSICAL THERAPIST)
(830) 774-1556
Entity
Organization
Contact information
Practice address
1308 N BEDELL AVE, DEL RIO, TX 78840-7818
(830) 774-1556
(830) 774-6150
Mailing address
1308 N BEDELL AVE, DEL RIO, TX 78840-7818
(830) 774-1556
(830) 774-6150
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
649830000/553250000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155663101
—
TX
01
—
26JB
BC/BS GROUP NUMBER
TX
01
—
351640200
US DEPT. OF LABOR GROUP #
TX
Enumeration date
09/16/2005
Last updated
01/15/2013
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