Provider Demographics
NPI:1306966197
Name:KLINGER, SHAWN D (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:D
Last Name:KLINGER
Suffix:
Gender:M
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 1:15893 MCDOUGLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUR LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77659
Mailing Address - Country:US
Mailing Address - Phone:409-981-6430
Mailing Address - Fax:409-287-4077
Practice Address - Street 1:HIGHWAY 326
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659
Practice Address - Country:US
Practice Address - Phone:409-981-6430
Practice Address - Fax:409-287-4077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT13832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer