Provider Demographics
NPI:1558784595
Name:POPPLE, RODNEY BURGESS (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:BURGESS
Last Name:POPPLE
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BUSINESS CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4416
Mailing Address - Country:US
Mailing Address - Phone:904-264-6304
Mailing Address - Fax:
Practice Address - Street 1:1550 BUSINESS CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4416
Practice Address - Country:US
Practice Address - Phone:904-264-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist