Provider Demographics
NPI:1477177137
Name:WASHBURN, JAMES THOMAS III (LAT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:WASHBURN
Suffix:III
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 1:1301 S PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-8201
Mailing Address - Country:US
Mailing Address - Phone:817-783-6940
Mailing Address - Fax:
Practice Address - Street 1:1301 S PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-8201
Practice Address - Country:US
Practice Address - Phone:817-783-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT4931OtherTDLR