Healthcare Provider Details

I. General information

NPI: 1821518168
Provider Name (Legal Business Name): TAYLOR MARIE HUFFMAN MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 FM 973
TAYLOR TX
76574-4524
US

IV. Provider business mailing address

201 HIGHLAND DR APT 511
TAYLOR TX
76574-1850
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-6326
  • Fax:
Mailing address:
  • Phone: 210-355-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT6806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: