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General NPI Number Information
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NPI Number | 1750863791
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Entity Type | Individual
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Provider Name | CAMERON PEASE
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Gender | Male
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 30461 GARNAND DR
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City | MEADOWVIEW
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State | VA
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Zip | 24361
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Country | US
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Telephone | 276-944-4121
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Fax |
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Provider Business Mailing Address
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Address Line | 4530 BLITSGEL DR
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City | FLORENCE
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State | SC
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Zip | 29501-9014
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Country | US
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Telephone |
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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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