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General NPI Number Information
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NPI Number | 1548492630
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Entity Type | Individual
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Provider Name | JEREMY BRETT TEBLUM MSED, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2009
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 265 E ROLLINS ST
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City | ORLANDO
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State | FL
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Zip | 32804
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Country | US
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Telephone | 813-727-6373
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Fax |
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Provider Business Mailing Address
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Address Line | 265 E ROLLINS ST
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City | ORLANDO
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State | FL
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Zip | 32804
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Country | US
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Telephone | 813-727-6373
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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 | AL6740
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License Number State | FL
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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 | AT7004
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License Number State | TX
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