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General NPI Number Information
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NPI Number | 1790992097
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Entity Type | Individual
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Provider Name | ANTHONY JAMES JEDWABNY ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 185 S WESTMONTE DR STE 1208
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-4200
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Country | US
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Telephone | 407-733-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 178 PESHEKEE TRAIL
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City | MEDFORD
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State | NJ
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Zip | 08055
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Country | US
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Telephone | 407-862-0714
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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 | AL1198
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License Number State | FL
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