Basic Information
| Provider Information | |||||||||
| NPI: | 1174612527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE SMIDT | ||||||||
| FirstName: | PIETER | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 CENTRAL PARKWAY NORTH | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105414500 | ||||||||
| FaxNumber: | 2105414508 | ||||||||
| Practice Location | |||||||||
| Address1: | 2235 THOUSAND OAKS DR | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782323969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104023856 | ||||||||
| FaxNumber: | 2104905921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1072643 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.