Healthcare Provider Details

I. General information

NPI: 1770047268
Provider Name (Legal Business Name): HEATHER WALDSCHMIDT MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 10/08/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 BULLDOG LN
MARION TX
78124-1741
US

IV. Provider business mailing address

17011 VISTA BLUFF DR
SAN ANTONIO TX
78247-4666
US

V. Phone/Fax

Practice location:
  • Phone: 830-914-2803
  • Fax:
Mailing address:
  • Phone: 210-422-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT8649
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: