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NPI Code Detail

MEDICARE: BENITO VELASQUEZ ATC LAT

MEDICARE: BENITO VELASQUEZ 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 TrainerAT 0113MS
22255A2300XAthletic TrainerAT4914TX

General Provider Information

NPI Number : 1194842021
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENITO VELASQUEZ ATC LAT
Provider Business Mailing Address
First Line : 3410 TAFT BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76308-2099
Country : US
Telephone Number : 940-397-4829
Fax Number : 940-397-4901
Provider Business Practice Location Address
First Line : 118 COLLEGE DR # 5142
Second Line : UNIVERSITY OF SOUTHERN MISSISSIPPI
City : HATTIESBURG
State : MS
Zip : 39406-0001
Country : US
Telephone Number : 601-266-6058
Fax Number : 601-266-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2007
Last Update Date : 08/04/2014

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Directions to “ BENITO VELASQUEZ ATC LAT” Practice Location

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