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General NPI Number Information
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NPI Number | 1467418517
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Entity Type | Individual
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Provider Name | KEVEN BARCLAY EICHORN LAT,ATC,CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 3201 N ORANGE AVE
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City | SARASOTA
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State | FL
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Zip | 34234-4744
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Country | US
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Telephone | 941-518-6957
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Fax |
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Provider Business Mailing Address
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Address Line | 122 167TH BLVD E
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City | BRADENTON
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State | FL
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Zip | 34212-5540
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Country | US
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Telephone | 941-758-0889
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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 | AL1153
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License Number State | FL
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