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General NPI Number Information
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NPI Number | 1366967101
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Entity Type | Individual
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Provider Name | EMILY RACHEL DINE
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Gender | Female
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Dates
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Enumeration Date | 08/12/2017
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Last Update Date | 08/12/2017
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Provider Practice Location Address
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Address Line | 812 UNIVERSITY
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City | PELLA
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State | IA
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Zip | 50219
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Country | US
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Telephone | 877-462-3687
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Fax |
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Provider Business Mailing Address
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Address Line | 823 JACARANDA DR
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City | OLDSMAR
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State | FL
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Zip | 34677-4566
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Country | US
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Telephone | 813-925-0527
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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 |
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License Number State |
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