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General NPI Number Information
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NPI Number | 1770465114
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Entity Type | Individual
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Provider Name | NATHANAEL NORTHEY LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 11605 E US HIGHWAY 92
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City | SEFFNER
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State | FL
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Zip | 33584-3305
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Country | US
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Telephone | 813-626-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 CASTLE ROCK CIR
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City | LAND O LAKES
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State | FL
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Zip | 34639-5580
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Country | US
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Telephone | 813-597-5079
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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 | 7527
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License Number State | FL
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