Healthcare Provider Details

I. General information

NPI: 1366535932
Provider Name (Legal Business Name): EMILY BETH SPEARS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NORTH UNIVERSITY STREET SUITE 2
MURFREESBORO TN
37130
US

IV. Provider business mailing address

5390 MORGAN CREEK ROAD
CENTERVILLE TN
37033
US

V. Phone/Fax

Practice location:
  • Phone: 615-310-8679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number939
License Number StateTN

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: