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General NPI Number Information
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NPI Number | 1588794630
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Entity Type | Individual
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Provider Name | AMY RENE' SRALLA A.T.C, L.A.T
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3250 LOOP 534
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City | KERRVILLE
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State | TX
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Zip | 78028-5448
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Country | US
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Telephone | 830-257-2212
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Fax | 830-896-2242
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Provider Business Mailing Address
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Address Line | 124 CEDAR WAY
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City | KERRVILLE
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State | TX
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Zip | 78028-7061
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Country | US
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Telephone | 830-257-2919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT2439
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License Number State | TX
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