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General NPI Number Information
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NPI Number | 1336607779
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Entity Type | Individual
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Provider Name | MADISON DUROCHER MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 2425 HIGHWAY 121
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City | BEDFORD
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State | TX
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Zip | 76021-5013
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Country | US
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Telephone | 817-540-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 STATE HIGHWAY 121 APT 1633
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City | EULESS
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State | TX
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Zip | 76039-6041
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Country | US
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Telephone | 774-722-4967
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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 |
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License Number State |
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