Provider Demographics
NPI:1124490958
Name:YOUSHAK, EMILY E (LAT, ATC, CSCS)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:E
Last Name:YOUSHAK
Suffix:
Gender:F
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:E
Other - Last Name:KRUITHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 SW WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3968
Mailing Address - Country:US
Mailing Address - Phone:386-627-3027
Mailing Address - Fax:
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:786-268-6200
Practice Address - Fax:786-533-9978
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL56052255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer