Provider Demographics
NPI:1013390889
Name:GILL, ALAN (ATC, LAT, OTC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:ATC, LAT, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 HAWTHORNE TRL
Mailing Address - Street 2:NONE
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9210
Mailing Address - Country:US
Mailing Address - Phone:972-463-4313
Mailing Address - Fax:
Practice Address - Street 1:3611 HAWTHORNE TRL
Practice Address - Street 2:NONE
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9210
Practice Address - Country:US
Practice Address - Phone:972-463-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT39232255A2300X
246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant