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General NPI Number Information
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NPI Number | 1447528922
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Entity Type | Organization
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Legal Business Name | RALLYSPORT
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 11 OAK CREEK DR SUITE E
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City | KAUFMAN
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State | TX
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Zip | 75142-3011
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Country | US
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Telephone | 972-932-1401
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Fax | 972-932-1404
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Provider Business Mailing Address
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Address Line | 11 OAK CREEK DR SUITE E
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City | KAUFMAN
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State | TX
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Zip | 75142-3011
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Country | US
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Telephone | 972-932-1401
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Fax | 972-932-1404
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC MCILROY
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Credential | PT
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Telephone | 972-932-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 671590000
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License Number State | TX
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