Healthcare Provider Details

I. General information

NPI: 1063723559
Provider Name (Legal Business Name): ERIN DAHLKE ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 W COLONIAL DR
OCOEE FL
34761-6918
US

IV. Provider business mailing address

8945 W COLONIAL DR
OCOEE FL
34761-6918
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-0023
  • Fax:
Mailing address:
  • Phone: 407-913-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: