Provider Demographics
NPI:1902310675
Name:CONWAY, EVA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134
Mailing Address - Country:US
Mailing Address - Phone:214-875-1725
Mailing Address - Fax:
Practice Address - Street 1:1323 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-1688
Practice Address - Country:US
Practice Address - Phone:214-875-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2000030387OtherATHLETIC TRAINER