Active NPI
Tracey Fontenot, P.T.
- Pediatric Physical Therapist
- San Antonio, TX
National Provider Identifier
1386091080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1107001
- Practice address
- 15316 Huebner Rd Ste 202
San Antonio, TX 78248-0994 - Phone
- (210) 614-4567
- NPI assigned
- May 23, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1107001 | TX | Primary |
Addresses
Primary practice location
15316 Huebner Rd Ste 202
San Antonio, TX 78248-0994
Mailing address
15316 Huebner Rd Ste 202
San Antonio, TX 78248-0994
Phone (210) 614-4567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1107001 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463961600000",
"number": "1386091080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15316 HUEBNER RD STE 202",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782480994",
"telephone_number": "210-614-4567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15316 HUEBNER RD STE 202",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782480994",
"telephone_number": "210-614-4567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "TRACEY",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-23",
"last_updated": "2016-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1107001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.