MEDICARE: ALEXANDER SEBASTIAN FREEMAN ATC, VA-LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126003532	VA

General Provider Information

NPI Number	:	1699294421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER SEBASTIAN FREEMAN ATC, VA-LAT

Provider Business Mailing Address
First Line	:	7801 LAUREL SPRING RD
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-3328
Country	:	US
Telephone Number	:	804-733-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 LAUREL SPRING RD
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-3328
Country	:	US
Telephone Number	:	804-733-2720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	03/05/2025

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