Provider Demographics
NPI:1295372779
Name:ESCALANTE, ERIC (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 RESEARCH FOREST DR APT 11304
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1580
Mailing Address - Country:US
Mailing Address - Phone:979-540-6707
Mailing Address - Fax:
Practice Address - Street 1:13802 CENTERFIELD DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6043
Practice Address - Country:US
Practice Address - Phone:281-737-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer