Provider Demographics
NPI:1083679054
Name:JJ PEARCE HIGH SCHOOL
Entity Type:Organization
Organization Name:JJ PEARCE HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/LAT
Authorized Official - Phone:469-593-5033
Mailing Address - Street 1:1600 N COIT RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2805
Mailing Address - Country:US
Mailing Address - Phone:469-593-5033
Mailing Address - Fax:469-593-5170
Practice Address - Street 1:1600 N COIT RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2805
Practice Address - Country:US
Practice Address - Phone:469-593-5033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT2456261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation