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NPI Code Detail

MEDICARE: SHELBY DALE MS, LAT, ATC

MEDICARE: SHELBY DALE MS, 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
12255A2300XAthletic TrainerAT7595TX

General Provider Information

NPI Number : 1891195483
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY DALE MS, LAT, ATC
Provider Business Mailing Address
First Line : 8407 STREAM RUN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-3936
Country : US
Telephone Number : 813-283-8313
Fax Number :
Provider Business Practice Location Address
First Line : 1 UTSA CIR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-1644
Country : US
Telephone Number : 813-283-8313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2014
Last Update Date : 05/20/2020

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Directions to “ SHELBY DALE MS, LAT, ATC” Practice Location

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