Provider Demographics
NPI:1962960914
Name:CANTU, KYNDAL ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:KYNDAL
Middle Name:ELIZABETH
Last Name:CANTU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYNDAL
Other - Middle Name:ELIZABETH
Other - Last Name:BIPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12508 JONES MALTSBERGER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4215
Mailing Address - Country:US
Mailing Address - Phone:888-590-4002
Mailing Address - Fax:210-590-4585
Practice Address - Street 1:2902 GOLIAD RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3973
Practice Address - Country:US
Practice Address - Phone:210-904-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28496055OtherDL