Provider Demographics
NPI:1316479264
Name:QUEEN, SABRINA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:QUEEN
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 1:105 N AUSTIN AVE
Mailing Address - Street 2:APT #9106
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-4239
Mailing Address - Country:US
Mailing Address - Phone:512-699-4213
Mailing Address - Fax:
Practice Address - Street 1:105 N AUSTIN AVE
Practice Address - Street 2:APT #9106
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4239
Practice Address - Country:US
Practice Address - Phone:512-699-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT56052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer