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General NPI Number Information
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NPI Number | 1194946178
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Entity Type | Organization
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Legal Business Name | BAYLOR UNIVERSITY ATHLETIC TRAINING
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 1500 S UNIVERSITY PARKS DR ATHLETIC TRAINING DEPT.
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City | WACO
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State | TX
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Zip | 76706-1211
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Country | US
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Telephone | 254-710-1234
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Fax | 254-710-4307
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Provider Business Mailing Address
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Address Line | 1500 S UNIVERSITY PARKS DR ATHLETIC TRAINING DEPT.
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City | WACO
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State | TX
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Zip | 76706-1211
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Country | US
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Telephone | 254-710-1234
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Fax | 254-710-4307
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | MICHAEL R SIMS
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Credential | ATC, LAT
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Telephone | 254-710-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | TX
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