Provider Demographics
NPI:1801869763
Name:WEIR, DAVID JERRELL (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JERRELL
Last Name:WEIR
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 1:1609 BLUE QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6113
Mailing Address - Country:US
Mailing Address - Phone:979-764-9347
Mailing Address - Fax:
Practice Address - Street 1:TEXAS A&M ATHLETIC DEPARTMENT
Practice Address - Street 2:POB 30017
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77842-3017
Practice Address - Country:US
Practice Address - Phone:979-458-3662
Practice Address - Fax:979-847-8514
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT11442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer