Provider Demographics
NPI:1265761944
Name:KREBS, DAVID EDGAR (ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDGAR
Last Name:KREBS
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 1:7700 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-2233
Mailing Address - Country:US
Mailing Address - Phone:502-396-0726
Mailing Address - Fax:
Practice Address - Street 1:2001 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1863
Practice Address - Country:US
Practice Address - Phone:502-396-0726
Practice Address - Fax:502-272-7341
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT 1852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer