Provider Demographics
NPI:1396711545
Name:MAURER, JIM D (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:D
Last Name:MAURER
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 1:1 COWBOYS PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4924
Mailing Address - Country:US
Mailing Address - Phone:972-556-9991
Mailing Address - Fax:972-556-9993
Practice Address - Street 1:1 COWBOYS PKWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4924
Practice Address - Country:US
Practice Address - Phone:972-556-9991
Practice Address - Fax:972-556-9993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT10242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer