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General NPI Number Information
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NPI Number | 1861458671
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Entity Type | Individual
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Provider Name | KURTIS RICHARD FREUND ATC
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6904 PROVIDENCE PARK DR S
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City | MOBILE
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State | AL
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Zip | 36695-4600
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Country | US
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Telephone | 251-639-2096
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Fax | 251-639-2711
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Provider Business Mailing Address
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Address Line | 11574 COUNTY ROAD 54
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City | DAPHNE
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State | AL
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Zip | 36526-8444
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Country | US
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Telephone | 251-802-5915
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Fax | 251-639-2711
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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 | 862
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License Number State | AL
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