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General NPI Number Information
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NPI Number | 1356616098
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Entity Type | Organization
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Legal Business Name | ALLIANT REHABILITATION AND SPORTS THERAPY, PLLC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 4504 LILAC LN STE 1
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City | VICTORIA
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State | TX
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Zip | 77901-2625
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Country | US
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Telephone | 361-572-0385
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Fax | 361-572-0382
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Provider Business Mailing Address
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Address Line | 4504 LILAC LN STE 1
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City | VICTORIA
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State | TX
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Zip | 77901-2625
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KERRY HENNEKE
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Credential | PT
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Telephone | 361-935-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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