Edwin L Detweiler, ATC, PTA
Individual provider Active NPI Athletic Trainer · Weatherford, OK
NPI 1144539685 · NPPES record last updated Nov 22, 2011
Key facts
- NPI
- 1144539685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 624 (OK)
- Practice address
- 100 Campus Dr
Weatherford, OK 73096-3001 - Phone
- (864) 616-4448
- NPI assigned
- Oct 1, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1021 | OK | |
| Athletic Trainer | 2255A2300X | 624 | OK | Yes |
Addresses
Primary practice location
100 Campus Dr
Weatherford, OK 73096-3001
Mailing address
100 Campus Dr
Weatherford, OK 73096-3001
Phone (864) 616-4448
Other providers in Weatherford, OK
- Abegail Leann Daniels
- Summer Teahna Davenport
- Nicole Dawn Davidson
- Joy L Deleon
- Yanitza Delgado Tresord
- Pauline Diehl
- Stephen Dixon
- Thomas Andrew Dixon
- Jodi Doshier
- Michelle Douglas
All providers in Weatherford, OK · Athletic Trainer in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.