Provider Demographics
NPI:1316350812
Name:FREE, JEREMY (ATC/L)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:FREE
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CHAPEL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6038
Mailing Address - Country:US
Mailing Address - Phone:256-238-3320
Mailing Address - Fax:
Practice Address - Street 1:651 MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2789
Practice Address - Country:US
Practice Address - Phone:205-608-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer