Healthcare Provider Details

I. General information

NPI: 1275560054
Provider Name (Legal Business Name): MICHAEL BURTON TERRILL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FISK AVE
BROWNWOOD TX
76801-2715
US

IV. Provider business mailing address

2301 BELMEADE ST
BROWNWOOD TX
76801-5733
US

V. Phone/Fax

Practice location:
  • Phone: 325-649-8101
  • Fax: 325-649-8908
Mailing address:
  • Phone: 325-649-8101
  • Fax: 325-649-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 1586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: