Individual
MR. DEXTER LISING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
300 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(500) 555-5555
Mailing address
1715 W CESAR CHAVEZ ST, ATTN: DEXTER LISING, AUSTIN, TX 78703-4605
(555) 555-5555
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT7126
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2016
Last updated
02/18/2021
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