Individual
ALEX A BREITENWISCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
1500 S UNIVERSITY PARKS DR, WACO, TX 76706-1731
(254) 710-8136
(254) 710-3377
Mailing address
1500 S UNIVERSITY PARKS DR, WACO, TX 76706-1731
(254) 709-9032
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1619
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012168
NATA MEMBERSHIP
—
01
—
2000002577
BOC CERTIFICATION
—
01
—
AT4649
STATE LICENSE
TX
Enumeration date
08/23/2009
Last updated
03/10/2020
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