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General NPI Number Information
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NPI Number | 1841968955
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Entity Type | Individual
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Provider Name | REBECCA RENE DAVID MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 1605 AVE OF CHAMPIONS ROOM 1820 DIDDLE ARENA
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City | BOWLING GREEN
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State | KY
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Zip | 42101
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Country | US
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Telephone | 270-745-3743
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Fax | 270-745-3409
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Provider Business Mailing Address
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Address Line | 160 COACHMAN CT APT D
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City | BOWLING GREEN
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State | KY
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Zip | 42103-8576
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Country | US
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Telephone | 719-252-4235
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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 | TCA011
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License Number State | KY
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