Provider Demographics
NPI:1538219738
Name:POWELL, DAVID GRAHAM (MED, ATC, LAT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GRAHAM
Last Name:POWELL
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 TOPHILL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3443
Mailing Address - Country:US
Mailing Address - Phone:210-824-0995
Mailing Address - Fax:
Practice Address - Street 1:243 TOPHILL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3443
Practice Address - Country:US
Practice Address - Phone:210-824-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT17752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer