MEDICARE: CDM BOXING ASSOCIATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Y00000X	Clinical Exercise Physiologist
2	226300000X	Kinesiotherapist
3	225800000X	Recreation Therapist
4	2255A2300X	Athletic Trainer
5	2251S0007X	Sports Physical Therapist
6	174H00000X	Health Educator

General Provider Information

NPI Number	:	1144597832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDM BOXING ASSOCIATION

Provider Business Mailing Address
First Line	:	1007 STABLE SIDE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-6409
Country	:	US
Telephone Number	:	404-610-3046
Fax Number	:	281-443-1432

Provider Business Practice Location Address
First Line	:	1007 STABLE SIDE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-6409
Country	:	US
Telephone Number	:	404-610-3046
Fax Number	:	281-443-1432

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. FELICIA DAVIS-DARTHARD
Credential	:	M.S.
Telephone Number	:	404-610-3046

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	09/12/2016

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Directions to “CDM BOXING ASSOCIATION ” Practice Location

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