Healthcare Provider Details

I. General information

NPI: 1467425397
Provider Name (Legal Business Name): JENNIFER MARIE HUFFMAN ATC,LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 22ND PL
LUBBOCK TX
79410-1122
US

IV. Provider business mailing address

1903 75TH ST
LUBBOCK TX
79423-1614
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-4329
  • Fax:
Mailing address:
  • Phone: 806-786-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: