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NPI Code Detail

MEDICARE: ALEC JOSEPH PRIBULSKY MS, AT, LAT

MEDICARE: ALEC JOSEPH PRIBULSKY MS, AT, LAT
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 TrainerAT. 004278OH
22255A2300XAthletic TrainerAL 4242FL

General Provider Information

NPI Number : 1538610845
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEC JOSEPH PRIBULSKY MS, AT, LAT
Provider Business Mailing Address
First Line : 1201 N SCENIC HWY
Second Line :
City : BABSON PARK
State : FL
Zip : 33827-9751
Country : US
Telephone Number : 863-734-1502
Fax Number :
Provider Business Practice Location Address
First Line : 1201 N SCENIC HWY
Second Line :
City : BABSON PARK
State : FL
Zip : 33827-9751
Country : US
Telephone Number : 863-734-1502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2016
Last Update Date : 10/21/2016

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