Individual
NAM VU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 CENTRAL DR, BEDFORD, TX 76022
(817) 399-2306
Mailing address
709 W CEDAR ST, HURST, TX 76053-5521
(682) 521-9341
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5293
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT5293
TDLR
TX
Enumeration date
11/28/2020
Last updated
11/28/2020
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