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General NPI Number Information
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NPI Number | 1962934539
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Entity Type | Individual
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Provider Name | AARON THOMAS MAT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/01/2017
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Last Update Date | 04/01/2017
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Provider Practice Location Address
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Address Line | 3300 E CARTWRIGHT RD
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City | MESQUITE
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State | TX
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Zip | 75181-2530
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Country | US
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Telephone | 972-882-5232
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Fax |
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Provider Business Mailing Address
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Address Line | 5828 ANITA ST
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City | DALLAS
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State | TX
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Zip | 75206-5585
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Country | US
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Telephone | 940-782-9709
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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 | AT5279
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License Number State | TX
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