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NPI Code Detail

MEDICARE: BIANCA ALLEN LAT

MEDICARE:   BIANCA  ALLEN  LAT
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
12255A2300XAthletic TrainerAT6269TX

General Provider Information

NPI Number : 1295268175
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIANCA ALLEN LAT
Provider Business Mailing Address
First Line : 13470 FM 1485 RD
Second Line :
City : CONROE
State : TX
Zip : 77306-8119
Country : US
Telephone Number : 936-709-2000
Fax Number :
Provider Business Practice Location Address
First Line : 13470 FM 1485 RD
Second Line :
City : CONROE
State : TX
Zip : 77306-8119
Country : US
Telephone Number : 936-709-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2017
Last Update Date : 04/06/2017

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Directions to “ BIANCA ALLEN LAT” Practice Location

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