Healthcare Provider Details

I. General information

NPI: 1043285513
Provider Name (Legal Business Name): BRIAN K FARR M.A, ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SAN JACINTO BLVD BEL 222 D3700
AUSTIN TX
78712-1047
US

IV. Provider business mailing address

402 RED TAILED HAWK DR
PFLUGERVILLE TX
78660-8070
US

V. Phone/Fax

Practice location:
  • Phone: 512-471-9885
  • Fax: 512-471-0946
Mailing address:
  • Phone: 512-471-9885
  • Fax: 512-471-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 2303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: