Healthcare Provider Details

I. General information

NPI: 1992104608
Provider Name (Legal Business Name): BRANDON RUMPH ATC LAT EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NW 83RD ST BUILDING V
GAINESVILLE FL
32606-6210
US

IV. Provider business mailing address

3000 NW 83RD ST BUILDING V
GAINESVILLE FL
32606-6210
US

V. Phone/Fax

Practice location:
  • Phone: 352-395-5549
  • Fax:
Mailing address:
  • Phone: 352-395-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: