MEDICARE: MRS. SARA FURTADO 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	AT5748	TX

General Provider Information

NPI Number	:	1487007779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA FURTADO LAT, ATC

Provider Business Mailing Address
First Line	:	5143 WILDFLOWER DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-2154
Country	:	US
Telephone Number	:	210-865-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 FABULOUS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-3410
Country	:	US
Telephone Number	:	210-000-0000
Fax Number	:

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

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	04/30/2019

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