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NPI Code Detail

MEDICARE: ALEXANDER DAVID DAWSON ATC, LAT

MEDICARE: ALEXANDER DAVID DAWSON ATC, 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 TrainerAL3322FL

General Provider Information

NPI Number : 1871936955
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER DAVID DAWSON ATC, LAT
Provider Business Mailing Address
First Line : 7499 WINDOVER WAY
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7522
Country : US
Telephone Number : 321-514-1863
Fax Number :
Provider Business Practice Location Address
First Line : 712 CHENEY HWY
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-6959
Country : US
Telephone Number : 321-269-8155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2013
Last Update Date : 04/09/2013

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