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NPI Code Detail

MEDICARE: DANA ARIEL EDWARDS LAT,ATC

MEDICARE:   DANA ARIEL EDWARDS  LAT,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
12255A2300XAthletic TrainerAL4875FL

General Provider Information

NPI Number : 1275046609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA ARIEL EDWARDS LAT,ATC
Provider Business Mailing Address
First Line : 8970 SW 122ND PL APT 103
Second Line :
City : MIAMI
State : FL
Zip : 33186-4110
Country : US
Telephone Number : 706-202-1188
Fax Number :
Provider Business Practice Location Address
First Line : 1701 NE 127TH ST
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33181-2518
Country : US
Telephone Number : 305-892-7631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2017
Last Update Date : 11/07/2017

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Directions to “ DANA ARIEL EDWARDS LAT,ATC” Practice Location

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