Provider Demographics
NPI:1215313838
Name:BOYETTE, MARY ERIN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ERIN
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BEUTEL RD
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655
Mailing Address - Country:US
Mailing Address - Phone:979-587-5920
Mailing Address - Fax:
Practice Address - Street 1:3100 BEUTEL RD
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655
Practice Address - Country:US
Practice Address - Phone:979-587-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT5341OtherATHLETIC TRAINER