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General NPI Number Information
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NPI Number | 1770057234
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Entity Type | Individual
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Provider Name | ROBERT REYBURN MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 1 BATTLE CREEK WARRIOR BLVD
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City | REIDSVILLE
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State | GA
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Zip | 30453-5786
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Country | US
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Telephone | 920-660-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 552 E MAIN ST APT 830
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City | STATESBORO
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State | GA
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Zip | 30461-4263
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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 | AT002515
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License Number State | GA
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