JAE HWAN SONG (NPI# 1265823421) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265823421 |
| Entity Type | Individual |
| Full Name | JAE HWAN SONG |
| Credential | ATC |
| Practice Address |
640 Dr Mary Mcleod Bethune Blvd Handfiled Athletic Training Center Daytona Beach FL 32114-3012 |
| Mailing Address |
1400 Hancock Blvd Apt 1312 Daytona Beach FL 32114-5636 |
| Practice Telephone | 3864812261 |
| Mailing Telephone | 6198866597 |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AL3738 | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
640 DR MARY MCLEOD BETHUNE BLVD HANDFILED ATHLETIC TRAINING CENTER |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-3012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922074293 | Brian William Jansen | Specialist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2006-02-27 |
| 1467052399 | Kasiim Shakir Barr | Psychologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2020-10-29 |
| 1770199416 | Nikkita Nozistel | Student in an Organized Health Care Education/Training Program | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2020-09-18 |
| 1629691985 | Sydney Viar | Student in an Organized Health Care Education/Training Program | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2020-05-21 |
| 1154978575 | Zumondrae Newsome | Specialist/Technologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2019-08-20 |
| 1659859544 | Tamera Alexis Demps | Specialist/Technologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2018-08-01 |
| 1033697479 | Bria Jones | Specialist/Technologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2018-07-28 |
| 1295236057 | Stephone Delano Devante Baker | Kinesiotherapist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2018-02-26 |
| 1689128431 | Matthew Luers | Specialist/Technologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2016-08-10 |
| 1639549272 | Neville Willibe Spurgeon Jr. | Specialist/Technologist | 640 Dr Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114-3012 | 2015-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750910105 | Aracelis Guzman | Specialist/Technologist | 1400 S Nova Rd Apt 226, Daytona Beach, FL 32114-5847 | 2020-04-07 |
| 1629621081 | Glennika Walker | Specialist/Technologist | 600 Jimmy Ann Dr Apt 817, Daytona Beach, FL 32114-7407 | 2019-07-24 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1063913861 | Jason D Pendergraph | Specialist/Technologist | 2441 Bellevue Ave, Daytona Beach, FL 32114-5615 | 2018-02-27 |
| 1477928067 | Kayla Pearson | Specialist/Technologist | 101 Seabreeze Blvd, 301, Daytona Beach, FL 32118-4073 | 2015-12-08 |
| 1790175339 | Jamal Cort | Specialist/Technologist | 1026 Indian Oaks W, Daytona Beach, FL 32117-3114 | 2015-02-04 |
| 1578951893 | Brian Eschen | Specialist/Technologist | 2700 N Oleander Ave, Daytona Beach, FL 32118-3115 | 2015-01-09 |
| 1356774863 | Sandra Brendle | Specialist/Technologist | 212 Integra Shores Dr, Apt. 207, Daytona Beach, FL 32117-5577 | 2013-08-20 |
| 1720386725 | Scott Andrew Armstrong | Specialist/Technologist | 640 Mary Mcleod Bethune Blvd, Daytona Beach, FL 32114 | 2011-03-01 |
| 1679781280 | James Richard Pinyan Jr. | Specialist/Technologist | 1255 W International Speedway Blvd, Daytona Beach, FL 32114-2816 | 2007-05-18 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.