Active NPI
Alex A Breitenwischer, MS, LAT, ATC
- Athletic Trainer
- Waco, TX
National Provider Identifier
1447482559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT1619
- Practice address
- 1500 S University Parks Dr
Waco, TX 76706-1731 - Phone
- (254) 710-8136
- Fax
- (254) 710-3377
- NPI assigned
- Aug 23, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT1619 | TX | Primary |
Addresses
Primary practice location
1500 S University Parks Dr
Waco, TX 76706-1731
Mailing address
1500 S University Parks Dr
Waco, TX 76706-1731
Phone (254) 709-9032
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1012168 | Other | NATA MEMBERSHIP | |
| 2000002577 | Other | BOC CERTIFICATION | |
| AT4649 | Other | TX | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT1619 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583798400000",
"number": "1447482559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 S UNIVERSITY PARKS DR",
"city": "WACO",
"state": "TX",
"postal_code": "767061731",
"telephone_number": "254-709-9032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S UNIVERSITY PARKS DR",
"city": "WACO",
"state": "TX",
"postal_code": "767061731",
"telephone_number": "254-710-8136",
"fax_number": "254-710-3377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREITENWISCHER",
"first_name": "ALEX",
"middle_name": "A",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-23",
"last_updated": "2020-03-10",
"certification_date": "2020-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT1619",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA MEMBERSHIP",
"identifier": "1012168",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC CERTIFICATION",
"identifier": "2000002577",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "AT4649",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
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- Stacy Shook Brignac, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.