Provider Demographics
NPI:1972627669
Name:PASS, ANTHONY NICHOLAS SR (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:NICHOLAS
Last Name:PASS
Suffix:SR
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1157
Mailing Address - Country:US
Mailing Address - Phone:352-373-5307
Mailing Address - Fax:
Practice Address - Street 1:1 GALE LEMERAND DRIVE
Practice Address - Street 2:UNIVERSITY ATHLETIC ASSOCIATION, UNIVERSITY OF FLORIDA
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32604-2485
Practice Address - Country:US
Practice Address - Phone:352-375-4683
Practice Address - Fax:352-375-4805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL19722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer