Provider Demographics
NPI:1447416136
Name:BOURNE, ANASTASIA E (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:ANASTASIA
Middle Name:E
Last Name:BOURNE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:E
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1000 HWY 77 NORTH
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-923-4600
Mailing Address - Fax:972-923-4617
Practice Address - Street 1:1000 HWY 77 NORTH
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-923-4600
Practice Address - Fax:972-923-4617
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer