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General NPI Number Information
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NPI Number | 1144749714
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Entity Type | Individual
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Provider Name | EDISSON CANTOR
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Gender | Male
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 1 LELY HIGH SCHOOL BLVD
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City | NAPLES
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State | FL
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Zip | 34113-7823
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Country | US
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Telephone | 239-377-1937
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Fax | 239-377-2190
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Provider Business Mailing Address
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Address Line | 3306 W LEROY ST
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City | TAMPA
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State | FL
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Zip | 33607-1128
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Country | US
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Telephone | 813-545-7931
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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 | AL2603
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License Number State | FL
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