Jesse P Amburn, LAT,ATC
Specialist/Technologist, Athletic Trainer in Tyler, TX. Individual provider (NPI-1).
NPI number1992991947
StatusActive
Last updated in NPPESSep 23, 2007
Details
- NPI
- 1992991947
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jesse P Amburn
- Credential
- LAT,ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 23, 2007
- Last updated
- Sep 23, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT2013 | TX | Yes |
Practice location
3414 Golden RdTyler, TX 75701-8336
Phone 903-939-7500 · Fax 903-531-0179
Mailing address
3414 Golden RdTyler, TX 75701-8336
Phone 903-939-7500 · Fax 903-531-0179
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