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NPI Code Detail

MEDICARE: SAMANTHA BACHMAN ATC

MEDICARE: SAMANTHA BACHMAN ATC
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
12255A2300XAthletic TrainerAL3217FL

General Provider Information

NPI Number : 1912314576
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BACHMAN ATC
Provider Business Mailing Address
First Line : 1201 N SCENIC HWY
Second Line :
City : BABSON PARK
State : FL
Zip : 33827-9751
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1201 N SCENIC HWY
Second Line :
City : BABSON PARK
State : FL
Zip : 33827-9751
Country : US
Telephone Number : 863-638-2988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2014
Last Update Date : 07/16/2014

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