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General NPI Number Information
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NPI Number | 1063960045
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Entity Type | Individual
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Provider Name | REBECCA CARSON
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Gender | Female
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 4000 CENTRAL FLORIDA BLVD
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City | ORLANDO
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State | FL
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Zip | 32816-7801
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Country | US
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Telephone | 586-441-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 3693 OAKDALE CIR APT 201
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City | OVIEDO
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State | FL
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Zip | 32765-8097
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Country | US
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Telephone | 586-441-1170
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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 | AL5790
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License Number State | FL
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