Healthcare Provider Details

I. General information

NPI: 1083009104
Provider Name (Legal Business Name): TIMOTHY FELDMANN ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PL
MURFREESBORO NC
27855-1855
US

IV. Provider business mailing address

211 UNIVERSITY DR APT 4
MURFREESBORO NC
27855-1853
US

V. Phone/Fax

Practice location:
  • Phone: 252-398-6291
  • Fax: 252-398-6532
Mailing address:
  • Phone: 919-605-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-2530
License Number StateNC

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: