Healthcare Provider Details

I. General information

NPI: 1356624738
Provider Name (Legal Business Name): DUSTIN JAMES BOLING ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 N LAMAR BLVD SUITE C-65
AUSTIN TX
78752-1016
US

IV. Provider business mailing address

7801 N LAMAR BLVD SUITE C-65
AUSTIN TX
78752-1016
US

V. Phone/Fax

Practice location:
  • Phone: 512-476-0500
  • Fax: 512-462-0110
Mailing address:
  • Phone: 512-476-0500
  • Fax: 512-462-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberATP 44298
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License NumberATP 44298
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number44298
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: