Provider Demographics
NPI:1891895165
Name:THORELL, ALAN CARL (PT CSCS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:CARL
Last Name:THORELL
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873C EVA STREET
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 STREET
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0093Medicare ID - Type Unspecified
TX00628YMedicare ID - Type Unspecified