Provider Demographics
NPI:1124055090
Name:EDELL, DAVID L (LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:EDELL
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 CHERYL CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2930
Mailing Address - Country:US
Mailing Address - Phone:281-261-6031
Mailing Address - Fax:
Practice Address - Street 1:1625 STAFFORDSHIRE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6326
Practice Address - Country:US
Practice Address - Phone:281-261-9200
Practice Address - Fax:281-208-6117
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT10322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer