Active NPI
Irwin Alivo Tanedo
- Physical Therapy Assistant
- San Antonio, TX
National Provider Identifier
1932323599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2058013
- Practice address
- 902 Bandera Rd
San Antonio, TX 78228-4923 - Phone
- (210) 431-4513
- Fax
- (210) 431-4531
- NPI assigned
- Apr 12, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2058013 | TX | Primary |
Addresses
Primary practice location
902 Bandera Rd
San Antonio, TX 78228-4923
Mailing address
800 Basse Rd. Apt#511
San Antonio, TX 78212
Phone (210) 663-2029
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 |
|---|---|---|---|
| 2058013 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932323599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 BASSE RD. APT#511",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78212",
"telephone_number": "210-663-2029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "902 BANDERA RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782284923",
"telephone_number": "210-431-4513",
"fax_number": "210-431-4531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANEDO",
"first_name": "IRWIN",
"middle_name": "ALIVO",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2058013",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.