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General NPI Number Information
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NPI Number | 1144328626
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Entity Type | Individual
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Provider Name | JOSHUA MATT EZELL ATC
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 263 SEABOARD LN SUITE 200
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City | FRANKLIN
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State | TN
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Zip | 37067-8245
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Country | US
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Telephone | 615-417-0675
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Fax |
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Provider Business Mailing Address
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Address Line | 2923 KEDZIE DR
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City | MURFREESBORO
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State | TN
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Zip | 37130-3372
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Country | US
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Telephone | 615-417-0675
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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 | 0000000641
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License Number State | TN
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