Healthcare Provider Details

I. General information

NPI: 1043464241
Provider Name (Legal Business Name): PHOEBE M HOWARD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W NEWBERRY RD
GAINESVILLE FL
32607-2249
US

IV. Provider business mailing address

4820 W NEWBERRY RD
GAINESVILLE FL
32607-2249
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax: 352-373-1507
Mailing address:
  • Phone: 352-373-2116
  • Fax: 352-373-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number069902399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: