Provider Demographics
NPI:1194946178
Name:BAYLOR UNIVERSITY ATHLETIC TRAINING
Entity type:Organization
Organization Name:BAYLOR UNIVERSITY ATHLETIC TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LAT
Authorized Official - Phone:254-710-1234
Mailing Address - Street 1:1500 S UNIVERSITY PARKS DR
Mailing Address - Street 2:ATHLETIC TRAINING DEPT.
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1211
Mailing Address - Country:US
Mailing Address - Phone:254-710-1234
Mailing Address - Fax:254-710-4307
Practice Address - Street 1:1500 S UNIVERSITY PARKS DR
Practice Address - Street 2:ATHLETIC TRAINING DEPT.
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1211
Practice Address - Country:US
Practice Address - Phone:254-710-1234
Practice Address - Fax:254-710-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty