Provider Demographics
NPI:1205443553
Name:REID, EMMA (AT, ATC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24123 SNOWAPPLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-7805
Mailing Address - Country:US
Mailing Address - Phone:269-377-5453
Mailing Address - Fax:
Practice Address - Street 1:24123 SNOWAPPLE BLVD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-7805
Practice Address - Country:US
Practice Address - Phone:269-377-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer