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General NPI Number Information
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NPI Number | 1285041921
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Entity Type | Individual
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Provider Name | MICHAEL DOERSCH LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 3535 PIRATE NATION WAY
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City | PALM COAST
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State | FL
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Zip | 32137-9203
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Country | US
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Telephone | 920-660-2536
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Fax |
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Provider Business Mailing Address
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Address Line | 1526 S BOUNDARY ST
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City | DELAND
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State | FL
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Zip | 32720-8420
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Country | US
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Telephone | 920-660-2536
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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 | 1597-39
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL6971
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License Number State | FL
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