Provider Demographics
NPI:1447528922
Name:RALLYSPORT
Entity type:Organization
Organization Name:RALLYSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCILROY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-932-1401
Mailing Address - Street 1:11 OAK CREEK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-3011
Mailing Address - Country:US
Mailing Address - Phone:972-932-1401
Mailing Address - Fax:972-932-1404
Practice Address - Street 1:11 OAK CREEK DR
Practice Address - Street 2:SUITE E
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-3011
Practice Address - Country:US
Practice Address - Phone:972-932-1401
Practice Address - Fax:972-932-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671590000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy