MEDICARE: ALTA THERAPY CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164120291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA THERAPY CENTER PLLC

Provider Business Mailing Address
First Line	:	3440 RANCH TRL APT 2423
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2445
Country	:	US
Telephone Number	:	323-559-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 RANCH TRL APT 2423
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2445
Country	:	US
Telephone Number	:	323-559-6344
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	CIARYS RUBIO JUNG
Credential	:
Telephone Number	:	323-366-9561

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	03/30/2023

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