Healthcare Provider Details

I. General information

NPI: 1497873814
Provider Name (Legal Business Name): ALAN DAVID FREEDMAN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF EDUCATION 1015 WEST MAIN ST., BOX 842020
RICHMOND VA
23284-2020
US

IV. Provider business mailing address

13760 NILE RD
CHESTER VA
23831-5214
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-1948
  • Fax:
Mailing address:
  • Phone: 804-768-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: