=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881190601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVET RANAE FORGES LAT, MAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21000 FRANZ RD
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-5729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-237-7800
-----------------------------------------------------
Fax | 281-644-1745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12603 WHITE PLAINS DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77089-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-226-9558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT5947
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------