Organization
ALTA VISTA HEALTHCARE, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHANIEL E. MANGUM (CEO)
(214) 692-6666
Entity
Organization
Contact information
Practice address
1123 N MAIN AVE, SUITE 100, SAN ANTONIO, TX 78212-4740
(210) 822-6323
(210) 822-6356
Mailing address
5445 LA SIERRA DR, SUITE 204, DALLAS, TX 75231-4139
(214) 692-6666
(214) 692-6670
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1038107
—
Other
Enumeration date
07/31/2006
Last updated
08/22/2020
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