Basic Information
| Provider Information | |||||||||
| NPI: | 1235703026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALVILLO | ||||||||
| FirstName: | ALISA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8240 N MOPAC EXPY STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124103754 | ||||||||
| FaxNumber: | 5124079010 | ||||||||
| Practice Location | |||||||||
| Address1: | 16040 PARK VALLEY DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786813596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122482200 | ||||||||
| FaxNumber: | 5122481950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.