Healthcare Provider Details

I. General information

NPI: 1437670148
Provider Name (Legal Business Name): JOEL MUHLBACH ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 TWISTING SWEETGUM WAY
OCOEE FL
34761
US

IV. Provider business mailing address

2528 TWISTING SWEETGUM WAY
OCOEE FL
34761-7637
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-0320
  • Fax:
Mailing address:
  • Phone: 407-963-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000029524
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: