Provider Demographics
NPI:1922406255
Name:WEST, MICHAEL CHARLES (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:WEST
Suffix:
Gender:M
Credentials:MS, 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:PO BOX 7399
Mailing Address - Street 2:UNIVERSITY OF TEXAS ATHLETICS
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78713-7399
Mailing Address - Country:US
Mailing Address - Phone:512-232-3939
Mailing Address - Fax:512-232-5054
Practice Address - Street 1:2139 SAN JACINTO BLVD
Practice Address - Street 2:UNIVERSITY OF TEXAS ATHLETICS, NEZ B1.024A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-232-3939
Practice Address - Fax:512-232-5054
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT4175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist