Provider Demographics
NPI:1104869023
Name:TRUEMAN, PHILLIP J
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:TRUEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SONTERRA BLVD
Mailing Address - Street 2:300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-489-7270
Mailing Address - Fax:210-403-2445
Practice Address - Street 1:150 E SONTERRA BLVD
Practice Address - Street 2:300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-489-7270
Practice Address - Fax:210-403-2445
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5897434OtherAETNA
TX8T4097OtherBCBS
TX8E0561Medicare PIN
P78554Medicare UPIN