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General NPI Number Information
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NPI Number | 1831467893
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Entity Type | Individual
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Provider Name | MICHAEL METHVIN M.ED., ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 51 OSS/OHWS (PACAF) UNIT 2163
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City | APO
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State | AP
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Zip | 96278-2163
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Country | US
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Telephone | 108-466-8106
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 3 BOX 6046
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City | APO
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State | AP
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Zip | 96266-0061
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Country | US
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Telephone | 108-466-8106
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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 | AL3061
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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 | ATR-001492
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License Number State | AZ
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