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General NPI Number Information
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NPI Number | 1346206026
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Entity Type | Individual
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Provider Name | BERNARD JOSEPH LOUGH ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 4301 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78209-6318
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Country | US
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Telephone | 210-829-3834
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Fax | 210-841-7324
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Provider Business Mailing Address
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Address Line | 4301 BROADWAY ST CPO 288
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City | SAN ANTONIO
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State | TX
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Zip | 78209-6318
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Country | US
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Telephone | 210-283-6481
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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 | AT2804
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1289
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License Number State | OH
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