Provider Demographics
NPI:1316311285
Name:FIELD, MICHAEL (BS LAT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FIELD
Suffix:
Gender:M
Credentials:BS LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LAKE RD APT 148
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5706
Mailing Address - Country:US
Mailing Address - Phone:501-628-8767
Mailing Address - Fax:
Practice Address - Street 1:400 FM 350 S
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9447
Practice Address - Country:US
Practice Address - Phone:936-967-1569
Practice Address - Fax:936-967-8607
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer