Provider Demographics
NPI:1982245619
Name:REECE, ERIN BROOKE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BROOKE
Last Name:REECE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-3121
Mailing Address - Country:US
Mailing Address - Phone:678-986-0868
Mailing Address - Fax:
Practice Address - Street 1:3595 WEBB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4140
Practice Address - Country:US
Practice Address - Phone:678-986-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0036792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT003679OtherSTATE LICENSURE BOARD
BOC358711OtherBOARD OF CERTIFICATION