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General NPI Number Information
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NPI Number | 1518349786
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Entity Type | Individual
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Provider Name | STUART WELBORN LAT
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Gender | Male
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 3700 ROSS AVE # 30 SPORTS MEDICINE DEPT., FORESTER STADIUM
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City | DALLAS
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State | TX
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Zip | 75204-5422
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Country | US
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Telephone | 214-275-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 KINGSPOINT DR
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City | CARROLLTON
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State | TX
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Zip | 75007-5045
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Country | US
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Telephone | 713-503-7364
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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 | AT2098
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License Number State | TX
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