MEDICARE: TROY RABON MAT, 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	AT8464	TX

General Provider Information

NPI Number	:	1235806217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY RABON MAT, LAT, ATC

Provider Business Mailing Address
First Line	:	5800 UVALDE RD # N16.107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4513
Country	:	US
Telephone Number	:	281-998-6150
Fax Number	:	281-459-7606

Provider Business Practice Location Address
First Line	:	5800 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4513
Country	:	US
Telephone Number	:	281-998-6150
Fax Number	:	281-459-7606

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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