Provider Demographics
NPI:1861458671
Name:FREUND, KURTIS RICHARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:KURTIS
Middle Name:RICHARD
Last Name:FREUND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11574 COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8444
Mailing Address - Country:US
Mailing Address - Phone:251-802-5915
Mailing Address - Fax:251-639-2711
Practice Address - Street 1:6904 PROVIDENCE PARK DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4600
Practice Address - Country:US
Practice Address - Phone:251-639-2096
Practice Address - Fax:251-639-2711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer