Individual
CARSON LANE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
3001 UNIVERSITY BLVD, TYLER, TX 75701-7457
(417) 540-8634
Mailing address
3202 SHENANDOAH DR, TYLER, TX 75701-7449
(417) 540-8634
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6747
TX
Other
Enumeration date
09/14/2017
Last updated
09/14/2017
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