Provider Demographics
NPI:1588794630
Name:SRALLA, AMY RENE' (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENE'
Last Name:SRALLA
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7061
Mailing Address - Country:US
Mailing Address - Phone:830-257-2919
Mailing Address - Fax:
Practice Address - Street 1:3250 LOOP 534
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5448
Practice Address - Country:US
Practice Address - Phone:830-257-2212
Practice Address - Fax:830-896-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT24392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer