Provider Demographics
NPI:1225320492
Name:URBANOVSKY, FRED J (ATP)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:J
Last Name:URBANOVSKY
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1437
Mailing Address - Country:US
Mailing Address - Phone:512-694-6907
Mailing Address - Fax:
Practice Address - Street 1:2307 WALSH DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1437
Practice Address - Country:US
Practice Address - Phone:512-694-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP4732225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner