Healthcare Provider Details

I. General information

NPI: 1760182455
Provider Name (Legal Business Name): EMILY BIRCKHEAD ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VICTORIA ST
BRANDON FL
33510-4197
US

IV. Provider business mailing address

622 TEAL AVE
KISSIMMEE FL
34747-4663
US

V. Phone/Fax

Practice location:
  • Phone: 443-848-3314
  • Fax:
Mailing address:
  • Phone: 443-848-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: