Susan Detwiler, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT1887 Issued in TX

Practice address

2600 E Wisconsin Rd
Edinburg, TX 78542-6586

Phone

(956) 289-2402

Fax

(956) 289-2402

NPI assigned

Jan 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515456000000",
    "number": "1760999007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 S 8TH AVE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785395540",
            "telephone_number": "956-655-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E WISCONSIN RD",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785426586",
            "telephone_number": "956-289-2402",
            "fax_number": "956-289-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWILER",
        "first_name": "SUSAN",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-09",
        "last_updated": "2018-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT1887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Satish D Desai, M.D.
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• Ashley Nichole Desiga
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• Desmond Okey Ikondu, M.D., P.a.
• Diabetes & Endocrine Center, PA (Renaissance Medical Group)
• Thiendella Diagne, MD
• Andrew Edward Dials, LPA, MA
• Diaz-Garcia Counseling Services, PLLC
• Maria Elva Diaz-Garcia, LPC

• Athletic Trainer in Edinburg, TX
• Providers in Edinburg, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.