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General NPI Number Information
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NPI Number | 1841647534
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Entity Type | Individual
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Provider Name | STACIE MICHELLE SALAZAR MAT, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 793 UNION CHAPEL RD
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City | CEDAR CREEK
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State | TX
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Zip | 78612-3223
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Country | US
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Telephone | 805-835-2927
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Fax |
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Provider Business Mailing Address
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Address Line | 11001 S 1ST ST #1026
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City | AUSTIN
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State | TX
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Zip | 78748-6762
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Country | US
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Telephone | 805-835-2927
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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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