| Organization Name: | BOERNE SPECTRUM PHYSICAL THERAPY CLINIC |
| NPI Number: | 1003140831 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK STEPHEN MALONE (OWNER/PHYSICAL THERAPIST) |
| Mailing Address: | 264 Horse Hl Boerne |
| State: | TX US |
| Postal Code: | 780061963 |
| Phone Number: | 8303319443 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2009 |
| NPI Last Update Date: | 09/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 1164493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |