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General NPI Number Information
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NPI Number | 1376054296
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Entity Type | Individual
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Provider Name | NICOLAS BACH LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 1510 POLK ST
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City | HOUSTON
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State | TX
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Zip | 77002-7130
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Country | US
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Telephone | 713-391-4362
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Fax | 713-391-4362
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Provider Business Mailing Address
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Address Line | 4400 MEMORIAL DR APT 1099
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City | HOUSTON
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State | TX
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Zip | 77007-6300
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Country | US
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Telephone | 512-705-1351
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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 | 2000030300
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License Number State | TX
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