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General NPI Number Information
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NPI Number | 1912144718
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Entity Type | Individual
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Provider Name | ROBERT ALLAN ELDREDGE ATC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 325 CHERRY AVE
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City | MCKENZIE
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State | TN
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Zip | 38201
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Country | US
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Telephone | 731-352-6924
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Fax |
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Provider Business Mailing Address
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Address Line | 114 SPRUCE ST N
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City | BRUCETON
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State | TN
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Zip | 38317-2034
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Country | US
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Telephone | 731-535-1479
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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 | 1250
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License Number State | TN
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