Redentor Mabutas

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2181108 Issued in TX

Practice address

5100 John D Ryan Blvd
San Antonio, TX 78245-3527

Phone

(210) 677-8666

NPI assigned

Sep 18, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1891522231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 HUMMINGBIRD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782454470",
            "telephone_number": "210-473-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 JOHN D RYAN BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782453527",
            "telephone_number": "210-677-8666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4917 Ravenswood Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782274317",
            "country_code": "US",
            "telephone_number": "210-673-2761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MABUTAS",
        "first_name": "REDENTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2181108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Venessa Mabo Ngwambo
• Asoh Mbeh Mabo, FNP-C
• Jeffrey Caldwell Mabry, D.D.S.
• Nicole R Mabry, PHD
• Teresa Ann Mabry, LMSW
• Anthony Mac, OD
• Christopher Rolando Mac
• Nikolas De Guzman Macalma, HIS
• Jenna Macauley, DO, MS, FAAP
• Raul Armando Macchia, DNP

• Physical Therapy Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.