Provider Demographics
NPI:1962161455
Name:THE COMPLETE ATHLETE PERFORMANCE THERAPY LLC
Entity type:Organization
Organization Name:THE COMPLETE ATHLETE PERFORMANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-779-4656
Mailing Address - Street 1:2915 ABERCORN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3736
Mailing Address - Country:US
Mailing Address - Phone:361-779-4656
Mailing Address - Fax:
Practice Address - Street 1:11618 JONES MALTSBERGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2833
Practice Address - Country:US
Practice Address - Phone:210-593-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty