Healthcare Provider Details

I. General information

NPI: 1356494009
Provider Name (Legal Business Name): ROBIN DENISE ELDRIDGE MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 CUTSHAW AVE DANIEL BUILDING SUITE 299
RICHMOND VA
23230-3943
US

IV. Provider business mailing address

3825 APPLEWOOD RD
RICHMOND VA
23234-4824
US

V. Phone/Fax

Practice location:
  • Phone: 804-340-1193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000088
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: