Provider Demographics
NPI:1386057503
Name:BRANCH, JAMES (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BRANCH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WINDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4014
Mailing Address - Country:US
Mailing Address - Phone:904-728-6505
Mailing Address - Fax:
Practice Address - Street 1:142 WINDFLOWER WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4014
Practice Address - Country:US
Practice Address - Phone:904-728-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL38162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL3816OtherFLORIDA BOARD OF HEALTH ATHLETIC TRAINING LICENSURE