Provider Demographics
NPI:1316469463
Name:BATES, LEROY ANTHONY IV (MS,LAT,ATC)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:ANTHONY
Last Name:BATES
Suffix:IV
Gender:M
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12464 TIERRA ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4524
Mailing Address - Country:US
Mailing Address - Phone:915-490-1387
Mailing Address - Fax:
Practice Address - Street 1:12464 TIERRA ENCINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4524
Practice Address - Country:US
Practice Address - Phone:915-490-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT67342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer