Individual
LEROY SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, LMT
Contact information
Practice address
6060 DILBECK LN, DALLAS, TX 75240-5351
(972) 385-3643
Mailing address
943 LAKE GROVE DR, LITTLE ELM, TX 75068-8447
(504) 701-6845
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6743
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
BLUECROSS BLUESHIELD
TX
Enumeration date
08/02/2016
Last updated
08/02/2016
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