Healthcare Provider Details

I. General information

NPI: 1326374505
Provider Name (Legal Business Name): HEATHER A AMITRANI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 S LAKELINE BLVD, SUITE 100 TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
CEDAR PARK TX
78613-2964
US

IV. Provider business mailing address

2519 S LAKELINE BLVD, SUITE 100 TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
CEDAR PARK TX
78613-2964
US

V. Phone/Fax

Practice location:
  • Phone: 512-331-6200
  • Fax: 512-331-4312
Mailing address:
  • Phone: 512-331-6200
  • Fax: 512-331-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1190409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: