MEDICARE: MR. SHAWN D KLINGER 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	AT1383	TX

General Provider Information

NPI Number	:	1306966197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN D KLINGER A.T.C, L.A.T

Provider Business Mailing Address
First Line	:	15893 MCDOUGLE RD
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659
Country	:	US
Telephone Number	:	409-981-6430
Fax Number	:	409-287-4077

Provider Business Practice Location Address
First Line	:	HIGHWAY 326
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659
Country	:	US
Telephone Number	:	409-981-6430
Fax Number	:	409-287-4077

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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