Provider Demographics
NPI:1013453240
Name:OSWALT, BRITNI (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRITNI
Middle Name:
Last Name:OSWALT
Suffix:
Gender:F
Credentials:LAT, ATC
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 594
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440-0594
Mailing Address - Country:US
Mailing Address - Phone:903-474-4724
Mailing Address - Fax:
Practice Address - Street 1:903 E LENNON DR
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-5229
Practice Address - Country:US
Practice Address - Phone:903-474-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT61622255A2300X
TX20000170892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer