Provider Demographics
NPI:1548331994
Name:SILVESTRY, EDWARD JOSEPH JR (MT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:SILVESTRY
Suffix:JR
Gender:M
Credentials:MT
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:JOSEPH
Other - Last Name:SILVESTRY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:3002 FALL WAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3232
Mailing Address - Country:US
Mailing Address - Phone:210-367-0769
Mailing Address - Fax:866-867-8201
Practice Address - Street 1:3002 FALL WAY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3232
Practice Address - Country:US
Practice Address - Phone:210-367-0769
Practice Address - Fax:866-867-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT037399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist