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General NPI Number Information
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NPI Number | 1316369846
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SPORTS MEDICINE & ATHLETIC TRAINING CONSULTANT SERVICES,
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 5321 BENTGRASS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2136
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Country | US
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Telephone | 919-291-5917
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Fax |
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Provider Business Mailing Address
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Address Line | 5321 BENTGRASS DRIVE
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City | RALEIGH
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State | NC
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Zip | 27610
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Country | US
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Telephone | 919-291-5917
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SPORTS MEDICINE
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Name | DAVID M. MILLS
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Credential |
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Telephone | 919-291-5917
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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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