1326330796 NPI number — MR. JAY WALTER PIERSON SR. ATC, LAT, CSCS, PES

Table of content: MR. JAY WALTER PIERSON SR. ATC, LAT, CSCS, PES (NPI 1326330796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326330796 NPI number — MR. JAY WALTER PIERSON SR. ATC, LAT, CSCS, PES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERSON
Provider First Name:
JAY
Provider Middle Name:
WALTER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
ATC, LAT, CSCS, PES
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326330796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18200 KATY FWY FL 5
Provider Second Line Business Mailing Address:
ORTHOPEDICS & SPORTS MEDICINE DEPT
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77094-1285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-227-2445
Provider Business Mailing Address Fax Number:
832-825-9335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18200 KATY FWY FL 5
Provider Second Line Business Practice Location Address:
ORTHOPEDICS & SPORTS MEDICINE DEPT
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094-1285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-227-2445
Provider Business Practice Location Address Fax Number:
832-825-9335
Provider Enumeration Date:
05/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT2573 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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