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General NPI Number Information
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NPI Number | 1780019679
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Entity Type | Individual
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Provider Name | ALYSSA MUELLER A.T.C., L.A.T.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1130 BEACHVIEW ST SUITE 100
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 480-980-0410
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 SOUTHERN OAK DR APT 2081
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City | ARLINGTON
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State | TX
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Zip | 76011-2490
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Country | US
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Telephone |
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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 | AT5121
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License Number State | TX
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