Provider Demographics
NPI:1134243694
Name:ALCANTARA, RICKY H (ATC)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:H
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 WESTMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2585
Mailing Address - Country:US
Mailing Address - Phone:214-417-3922
Mailing Address - Fax:
Practice Address - Street 1:903 WESTMOUNT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2585
Practice Address - Country:US
Practice Address - Phone:214-417-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT27552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer