MEDICARE: SHELBY KINDRICK ATC, LAT

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	AT5563	TX

General Provider Information

NPI Number	:	1356772073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY KINDRICK ATC, LAT

Provider Business Mailing Address
First Line	:	3407 SCHROEDER AVE
Second Line	:
City	:	NEEDVILLE
State	:	TX
Zip	:	77461-8263
Country	:	US
Telephone Number	:	832-435-2745
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W NORRIS ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-2430
Country	:	US
Telephone Number	:	979-534-1867
Fax Number	:

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

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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