Provider Demographics
NPI:1851498802
Name:POWELL, DARIN SAMUEL (PTA, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:SAMUEL
Last Name:POWELL
Suffix:
Gender:M
Credentials:PTA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 LA GRANGE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5767
Mailing Address - Country:US
Mailing Address - Phone:903-223-4543
Mailing Address - Fax:
Practice Address - Street 1:2223 GALLERIA OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1601
Practice Address - Country:US
Practice Address - Phone:903-614-4440
Practice Address - Fax:903-614-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT15382255A2300X
TX2087190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer