Healthcare Provider Details

I. General information

NPI: 1003017781
Provider Name (Legal Business Name): THOMAS ALLEN SHILLER CO.,LO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E US HIGHWAY 77
SAN BENITO TX
78586-5424
US

IV. Provider business mailing address

PO BOX 331580
CORPUS CHRISTI TX
78463-1580
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-1129
  • Fax: 361-888-7424
Mailing address:
  • Phone: 361-888-7752
  • Fax: 361-888-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: