Provider Demographics
NPI:1972908564
Name:RAPPS, KEVIN (ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RAPPS
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 1:400 SW 258TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 SW 258TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4112
Practice Address - Country:US
Practice Address - Phone:352-472-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-26
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002333A2255A2300X
FLAL41442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36002333AOtherL.A.T
FLAL 4144OtherFLORIDA BOARD OF ATHLETIC TRAINING