MEDICARE: MR. MICHAEL ANDREW FOULDS A.T.C; L.A.T.

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	AT1325	TX

General Provider Information

NPI Number	:	1205893906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANDREW FOULDS A.T.C; L.A.T.

Provider Business Mailing Address
First Line	:	5868A-1 WESTHEIMER RD
Second Line	:	#459
City	:	HOUSTON
State	:	TX
Zip	:	77057-5641
Country	:	US
Telephone Number	:	713-417-2046
Fax Number	:	713-863-2369

Provider Business Practice Location Address
First Line	:	8945 LONG POINT RD
Second Line	:	#209
City	:	HOUSTON
State	:	TX
Zip	:	77055-3034
Country	:	US
Telephone Number	:	713-467-8886
Fax Number	:	713-467-0135

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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