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General NPI Number Information
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NPI Number | 1437381068
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Entity Type | Organization
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Legal Business Name | C & C THERAPY ALLIANCE, LLC
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Dates
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Enumeration Date | 08/16/2009
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Last Update Date | 08/16/2009
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Provider Practice Location Address
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Address Line | 5708 TOSCANA AVE
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City | AUSTIN
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State | TX
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Zip | 78724-6185
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Country | US
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Telephone | 512-659-8090
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Fax | 512-926-9997
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Provider Business Mailing Address
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Address Line | 5708 TOSCANA AVE
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City | AUSTIN
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State | TX
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Zip | 78724-6185
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Country | US
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Telephone | 512-659-8090
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Fax | 512-926-9997
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | URSULA COPULOS
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Credential | P.T.
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Telephone | 512-659-8090
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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 | 1152018
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License Number State | TX
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