Provider Demographics
NPI:1740581107
Name:ALAMO PHYSICAL THERAPY REHABILITATION
Entity Type:Organization
Organization Name:ALAMO PHYSICAL THERAPY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVERIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRUNEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:956-238-8854
Mailing Address - Street 1:317 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-4840
Mailing Address - Country:US
Mailing Address - Phone:956-283-8854
Mailing Address - Fax:956-283-8858
Practice Address - Street 1:317 E PARK AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-4840
Practice Address - Country:US
Practice Address - Phone:956-283-8854
Practice Address - Fax:956-283-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty