Provider Demographics
NPI:1174123210
Name:GUARDIOLA, JOSEPH (PTA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GUARDIOLA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2013
Mailing Address - Country:US
Mailing Address - Phone:210-922-0242
Mailing Address - Fax:
Practice Address - Street 1:3327 RESEARCH PLZ STE 404
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5159
Practice Address - Country:US
Practice Address - Phone:210-396-5210
Practice Address - Fax:210-396-5333
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098482225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2098482OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS