Individual
KELLY BUCKHOLZ SMALLBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19428 I-45 NORTH, SPRING, TX 77373
(281) 891-7084
(281) 891-7001
Mailing address
19428 I-45 NORTH, SPRING, TX 77373
(281) 891-7084
(281) 891-7001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6095
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000004828
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
01
—
AT6095
TEXAS DEPARTMENT OF LICENSING AND REGULATION
TX
Enumeration date
04/03/2018
Last updated
04/03/2018
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