Provider Demographics
NPI:1427080555
Name:SIMS, MICHAEL R (ATC LAT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:SIMS
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
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Mailing Address - Street 1:1200 HEATHERWOOD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3900
Mailing Address - Country:US
Mailing Address - Phone:254-857-9235
Mailing Address - Fax:254-710-4307
Practice Address - Street 1:1500 S UNIVERSITY PARKS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1211
Practice Address - Country:US
Practice Address - Phone:254-710-1021
Practice Address - Fax:254-710-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT05522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2255A2300XOtherATHLETIC TRAINER