MEDICARE: ALBERT ORILLANE LICENSED PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2132489	TX

General Provider Information

NPI Number	:	1528548765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT ORILLANE LICENSED PTA

Provider Business Mailing Address
First Line	:	119 JADE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1726
Country	:	US
Telephone Number	:	631-682-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2337
Country	:	US
Telephone Number	:	210-924-8151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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Directions to “ ALBERT ORILLANE LICENSED PTA” Practice Location

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