Provider Demographics
NPI:1174875694
Name:DURAN, LOUIS EDWARD (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:EDWARD
Last Name:DURAN
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 1:8604 VALLEY RANCH PKWY W
Mailing Address - Street 2:#3011
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4145
Mailing Address - Country:US
Mailing Address - Phone:210-632-4098
Mailing Address - Fax:
Practice Address - Street 1:323 PAUL BRYANT DR.
Practice Address - Street 2:ATHLETIC TRAINING ROOM
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-348-3612
Practice Address - Fax:205-348-3664
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer