MEDICARE: MRS. TERRY LYNN K MURPHY

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	975385	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2255A2300X	OTHER	TX	BOC , PROVIDER TYPE 22
2	099902393	OTHER	TX	NATA-BOC

General Provider Information

NPI Number	:	1770990822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERRY LYNN K MURPHY

Provider Business Mailing Address
First Line	:	PO BOX 7399
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78713-7399
Country	:	US
Telephone Number	:	512-471-7365
Fax Number	:	512-232-5054

Provider Business Practice Location Address
First Line	:	2012 ROBERT DEDMAN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78712-1754
Country	:	US
Telephone Number	:	512-471-7365
Fax Number	:	512-232-5054

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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