Provider Demographics
NPI:1083761530
Name:ALAN C. THORELL
Entity Type:Organization
Organization Name:ALAN C. THORELL
Other - Org Name:MONTGOMERY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:THORELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:936-597-5323
Mailing Address - Street 1:873C EVA ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1808
Mailing Address - Country:US
Mailing Address - Phone:936-597-5323
Mailing Address - Fax:936-597-8914
Practice Address - Street 1:873C EVA ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1808
Practice Address - Country:US
Practice Address - Phone:936-597-5323
Practice Address - Fax:936-597-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00628YMedicare ID - Type Unspecified