Healthcare Provider Details

I. General information

NPI: 1487850632
Provider Name (Legal Business Name): DANIEL H HUFFMAN ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSIE AND EMMIT STREET
CHARLOTTESVILLE VA
22903
US

IV. Provider business mailing address

1821 ROAD 63
POTTER NE
69156
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-2418
  • Fax:
Mailing address:
  • Phone: 308-235-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126001065
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: