Most Relevant Information
Provider Data
| NPI Number: | 1003487034 |
| Provider Name: | MICHELLE RENEA MASTON PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 2082671 |
Most Important Dates
| Enumeration Date: | 07/09/2021 |
| Last Updated: | 07/09/2021 |
Provider Practice Location
2535 PORTOLA VW
SAN ANTONIO
TX
782612578
Practice Location Phone/Fax
| Phone: | 2108850254 |
| Fax: |
Provider Mailing Location
2535 PORTOLA VW
SAN ANTONIO
TX
782612578
Provider Mailing Phone/Fax
| Phone: | 2108850254 |
| Fax: |