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NPI Code Detail

MEDICARE: T ROSS BAILEY ATC., LAT

MEDICARE:   T ROSS BAILEY  ATC., LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer412TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12255A2300XOTHERTXATHLETIC TRAINER

General Provider Information

NPI Number : 1013937259
Entity Type Code : Individual
Provider Name (Legal Business Name) : T ROSS BAILEY ATC., LAT
Provider Business Mailing Address
First Line : 7625 RAMBLE WOOD TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-3509
Country : US
Telephone Number : 817-257-7009
Fax Number :
Provider Business Practice Location Address
First Line : 3500 BELLAIRE DR N
Second Line : TCU ATHLETICS DEPT.
City : FORT WORTH
State : TX
Zip : 76129-0001
Country : US
Telephone Number : 817-257-7009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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Directions to “ T ROSS BAILEY ATC., LAT” Practice Location

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