Provider Demographics
NPI:1457677155
Name:LENORMAN, DUSTIN RAY (ATC)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:RAY
Last Name:LENORMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 SLEEPY PT
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-7918
Mailing Address - Country:US
Mailing Address - Phone:936-577-7368
Mailing Address - Fax:
Practice Address - Street 1:5102 SLEEPY PT
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-7918
Practice Address - Country:US
Practice Address - Phone:936-577-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT38662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer