Basic Information
| Provider Information | |||||||||
| NPI: | 1760898894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIMENTEL | ||||||||
| FirstName: | SILAS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461429430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173329861 | ||||||||
| FaxNumber: | 3178934453 | ||||||||
| Practice Location | |||||||||
| Address1: | 5720 BANDERA RD STE 14 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102988866 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05013627A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1310793 | 01 | TX | LINKING SELF PHYSICAL THERAPY LICENSE TO NPI | OTHER |