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General NPI Number Information
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NPI Number | 1104206705
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Entity Type | Individual
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Provider Name | JEREMY DANIEL HOWARD ATC, CES, PES
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Gender | Male
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 28811 S TAMIAMI TRL SUITE #13
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3201
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Country | US
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Telephone | 239-221-7123
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Fax | 239-221-7987
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Provider Business Mailing Address
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Address Line | 17460 ORIOLE RD
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City | FORT MYERS
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State | FL
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Zip | 33967-5104
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Country | US
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Telephone | 239-898-9131
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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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