Provider Demographics
NPI:1235538265
Name:TWILLEAGER, STEPHEN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:TWILLEAGER
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 1:1400 SAYLES BLVD
Mailing Address - Street 2:MCM STATION BOX 188
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79697
Mailing Address - Country:US
Mailing Address - Phone:254-702-4913
Mailing Address - Fax:
Practice Address - Street 1:900 COLLEGE ST # 8011
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2578
Practice Address - Country:US
Practice Address - Phone:254-295-5034
Practice Address - Fax:254-295-5027
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63012255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741161940OtherTAX ID NUMBER