MEDICARE: MR. ROBERT RICHARD MARLEY ATC, LAT, CSCS

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	AT0707	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AT0707	OTHER	TX	TEXAS DEPT. OF HEALTH LIC

General Provider Information

NPI Number	:	1679548382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RICHARD MARLEY ATC, LAT, CSCS

Provider Business Mailing Address
First Line	:	4607 BLUE ROSE CIR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2906
Country	:	US
Telephone Number	:	713-410-8041
Fax Number	:	281-494-0515

Provider Business Practice Location Address
First Line	:	15200 SOUTHWEST FWY
Second Line	:	SUITE 175
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3845
Country	:	US
Telephone Number	:	281-494-0550
Fax Number	:	281-494-0515

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. ROBERT RICHARD MARLEY ATC, LAT, CSCS” Practice Location

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