Healthcare Provider Details

I. General information

NPI: 1679181028
Provider Name (Legal Business Name): KYLE DANIEL HUFF ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E FAIRVIEW AVE
MONTGOMERY AL
36106-2114
US

IV. Provider business mailing address

2000 BERRY CHASE PL
MONTGOMERY AL
36117-6896
US

V. Phone/Fax

Practice location:
  • Phone: 334-833-4088
  • Fax: 334-833-4026
Mailing address:
  • Phone: 404-535-1322
  • Fax: 334-833-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1512
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: