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General NPI Number Information
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NPI Number | 1225580079
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Entity Type | Individual
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Provider Name | THOMAS SWAIN ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 2624 MEADOW GRN
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City | BEDFORD
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State | TX
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Zip | 76021-4924
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Country | US
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Telephone | 254-968-0545
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Fax |
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Provider Business Mailing Address
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Address Line | 2624 MEADOW GRN
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City | BEDFORD
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State | TX
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Zip | 76021-4924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AT6709
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License Number State | TX
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