MEDICARE: HEATHER DUBS MS, LAT, SCAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1026002564	VA
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1043610546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DUBS MS, LAT, SCAT, ATC

Provider Business Mailing Address
First Line	:	2945 ALPINE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2701
Country	:	US
Telephone Number	:	843-530-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 ALPINE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2701
Country	:	US
Telephone Number	:	843-530-6860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/25/2018

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