Healthcare Provider Details

I. General information

NPI: 1265819320
Provider Name (Legal Business Name): EMILY HILDEBRAND PHD, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 YORK RD TOWSON UNIVERSITY
TOWSON MD
21252-0001
US

IV. Provider business mailing address

17706 OLD FREDERICK RD
MOUNT AIRY MD
21771-3606
US

V. Phone/Fax

Practice location:
  • Phone: 410-704-3174
  • Fax:
Mailing address:
  • Phone: 410-704-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000728
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004048
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: