Provider Demographics
NPI:1386903383
Name:ST MARY'S THERAPY, INC
Entity type:Organization
Organization Name:ST MARY'S THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-710-0588
Mailing Address - Street 1:4203 GARDENDALE ST
Mailing Address - Street 2:103-C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3174
Mailing Address - Country:US
Mailing Address - Phone:210-710-0588
Mailing Address - Fax:
Practice Address - Street 1:4203 GARDENDALE ST
Practice Address - Street 2:103-C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3174
Practice Address - Country:US
Practice Address - Phone:210-710-0588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health