Provider Demographics
NPI:1528548765
Name:ORILLANE, ALBERT (LICENSED PTA)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:ORILLANE
Suffix:
Gender:M
Credentials:LICENSED PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 JADE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1726
Mailing Address - Country:US
Mailing Address - Phone:631-682-0249
Mailing Address - Fax:
Practice Address - Street 1:3030 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2337
Practice Address - Country:US
Practice Address - Phone:210-924-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2132489225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant