Provider Demographics
NPI:1417598129
Name:BILLINGSLEA, AMY KATHERINE (LAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:BILLINGSLEA
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E LYNNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1740
Mailing Address - Country:US
Mailing Address - Phone:903-399-4852
Mailing Address - Fax:
Practice Address - Street 1:3101 SPRING HILL RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2822
Practice Address - Country:US
Practice Address - Phone:903-446-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer