Individual
TAYLOR NICOLE THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC
Contact information
Practice address
11210 W US 290 HWY # A230, AUSTIN, TX 78737-1902
(512) 362-8865
Mailing address
11210 W US 290 HWY # A230, AUSTIN, TX 78737-1902
(512) 362-8865
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT7966
TX
Other
Enumeration date
01/24/2019
Last updated
05/27/2020
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