MEDICARE: MRS. KEAGHAN SCHULTE LAT, 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

General Provider Information

NPI Number	:	1225508898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEAGHAN SCHULTE LAT, ATC

Provider Business Mailing Address
First Line	:	4224 ALFALFA DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-2016
Country	:	US
Telephone Number	:	913-530-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 SIGMA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4439
Country	:	US
Telephone Number	:	913-530-1148
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	06/27/2022

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