MEDICARE: MR. LEE HUNT KNOX A.T.C.; L.A.T.

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	AT0713	TX

General Provider Information

NPI Number	:	1992798458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE HUNT KNOX A.T.C.; L.A.T.

Provider Business Mailing Address
First Line	:	650 DEFORREST ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-2737
Country	:	US
Telephone Number	:	361-857-8634
Fax Number	:

Provider Business Practice Location Address
First Line	:	6613 RANGER AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-5924
Country	:	US
Telephone Number	:	361-878-2334
Fax Number	:	361-878-4888

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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