MEDICARE: JAMES AUTRY

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	:	1255863288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES AUTRY

Provider Business Mailing Address
First Line	:	4029 TARPON SPRINGS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3416
Country	:	US
Telephone Number	:	850-361-9837
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 TARPON SPRINGS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3416
Country	:	US
Telephone Number	:	850-361-9837
Fax Number	:

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

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/29/2017

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Directions to “ JAMES AUTRY ” Practice Location

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