Healthcare Provider Details

I. General information

NPI: 1457383432
Provider Name (Legal Business Name): ROBERT T FLOYD EDD, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATION#14, UWA
LIVINGSTON AL
35470
US

IV. Provider business mailing address

STATION#14, UWA
LIVINGSTON AL
35470
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-3714
  • Fax: 205-652-3799
Mailing address:
  • Phone: 205-652-3714
  • Fax: 205-652-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number137
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: