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General NPI Number Information
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NPI Number | 1063058543
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Entity Type | Individual
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Provider Name | CORTNEY POPOWITZ
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 6901 NW 70TH AVE
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City | TAMARAC
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State | FL
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Zip | 33321-5315
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Country | US
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Telephone | 754-322-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 NW 161ST AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1170
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Country | US
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Telephone | 954-483-4598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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