Provider Demographics
NPI:1144475534
Name:KINGSWAY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:KINGSWAY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWANISHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHORUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-759-9757
Mailing Address - Street 1:5309 WURZBACH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2431
Mailing Address - Country:US
Mailing Address - Phone:210-759-9757
Mailing Address - Fax:210-761-5191
Practice Address - Street 1:5309 WURZBACH RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2431
Practice Address - Country:US
Practice Address - Phone:210-759-9757
Practice Address - Fax:210-761-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty