Provider Demographics
NPI:1396848263
Name:RALPH, VICKI LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:RALPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:468 S SEGUIN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-606-8839
Mailing Address - Fax:830-606-0577
Practice Address - Street 1:468 S SEGUIN AVE
Practice Address - Street 2:STE 100
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-606-8839
Practice Address - Fax:830-606-0577
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P11420Medicare UPIN
802T37Medicare ID - Type Unspecified