Provider Demographics
NPI:1427085463
Name:BASS, JEFFREY ALLAN (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:BASS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 OWL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6827
Mailing Address - Country:US
Mailing Address - Phone:432-557-7474
Mailing Address - Fax:
Practice Address - Street 1:13340 HIGHLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2000
Practice Address - Country:US
Practice Address - Phone:682-885-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT05612255A2300X
TXATO5612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer