Provider Demographics
NPI:1518349786
Name:WELBORN, STUART (LAT)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:WELBORN
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 1:1616 KINGSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5045
Mailing Address - Country:US
Mailing Address - Phone:713-503-7364
Mailing Address - Fax:
Practice Address - Street 1:3700 ROSS AVE # 30
Practice Address - Street 2:SPORTS MEDICINE DEPT., FORESTER STADIUM
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5422
Practice Address - Country:US
Practice Address - Phone:214-275-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer