Provider Demographics
NPI:1417364829
Name:REED, DAVID (LAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 W BAILEY BOSWELL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4808
Mailing Address - Country:US
Mailing Address - Phone:817-237-3314
Mailing Address - Fax:817-237-5384
Practice Address - Street 1:5805 W BAILEY BOSWELL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4808
Practice Address - Country:US
Practice Address - Phone:817-237-3314
Practice Address - Fax:817-237-5384
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT21032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer