Provider Demographics
NPI:1013937259
Name:BAILEY, T ROSS (ATC, LAT)
Entity type:Individual
Prefix:
First Name:T
Middle Name:ROSS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 RAMBLE WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3509
Mailing Address - Country:US
Mailing Address - Phone:817-257-7009
Mailing Address - Fax:
Practice Address - Street 1:3500 BELLAIRE DR N
Practice Address - Street 2:TCU ATHLETICS DEPT.
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76129-0001
Practice Address - Country:US
Practice Address - Phone:817-257-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2255A2300XOtherATHLETIC TRAINER