Provider Demographics
NPI:1386853992
Name:FEUERBACH, KATHLEEN H (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:H
Last Name:FEUERBACH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5053
Mailing Address - Country:US
Mailing Address - Phone:772-834-8605
Mailing Address - Fax:
Practice Address - Street 1:3100 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3722
Practice Address - Country:US
Practice Address - Phone:407-835-4900
Practice Address - Fax:407-245-2758
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2255A2300XOtherATHLETIC TRAINER