MEDICARE: JOSHUA HALE ATC

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
1	2255A2300X	Athletic Trainer	AT6176	TX

General Provider Information

NPI Number	:	1033977749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA HALE ATC

Provider Business Mailing Address
First Line	:	301 SHAWNEE TRL
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-4935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 THOMPSON RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6902
Country	:	US
Telephone Number	:	817-744-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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