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General NPI Number Information
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NPI Number | 1235249947
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Entity Type | Individual
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Provider Name | TIMOTHY DAVID FERREN ATC/LAT.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 700 E 2 MILE LINE RD
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City | MISSION
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State | TX
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Zip | 78574-1759
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Country | US
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Telephone | 956-323-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 LAS BRISAS DR
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City | MISSION
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State | TX
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Zip | 78574-2784
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Country | US
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Telephone | 956-874-3300
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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 | AT4129
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License Number State | TX
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