Healthcare Provider Details

I. General information

NPI: 1841399805
Provider Name (Legal Business Name): MEREDITH LIN SWAYNE L.A.T., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 FERGUSON RD
DALLAS TX
75228-3818
US

IV. Provider business mailing address

1835 VIEWCREST DR
DALLAS TX
75228-4215
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-3607
  • Fax:
Mailing address:
  • Phone: 682-597-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT3088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: