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General NPI Number Information
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NPI Number | 1295261147
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Entity Type | Individual
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Provider Name | ALEX BURDEKIN LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | OHWS FLUGPLATZ SPANGDAHLEM 108
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City | SPANGDAHLEM
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State | GERMANY
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Zip | 54529
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Country | DE
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Telephone | 585-259-2383
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 9 BOX 3982
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City | APO
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State | AE
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Zip | 09123-0040
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Country | US
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Telephone | 525-259-2383
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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 | LAT-3912
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License Number State | NC
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