Provider Demographics
NPI:1235249947
Name:FERREN, TIMOTHY DAVID (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:FERREN
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LAS BRISAS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2784
Mailing Address - Country:US
Mailing Address - Phone:956-874-3300
Mailing Address - Fax:
Practice Address - Street 1:700 E 2 MILE LINE RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-1759
Practice Address - Country:US
Practice Address - Phone:956-323-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000042585OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION
TXAT4129OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES