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NPI Code Detail

MEDICARE: SUMMER ROBERTSON ATC, CSCS

MEDICARE: SUMMER ROBERTSON ATC, CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1093840233
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMMER ROBERTSON ATC, CSCS
Provider Business Mailing Address
First Line : 10319 COMMERCE AVE APT 10
Second Line :
City : TUJUNGA
State : CA
Zip : 91042-1984
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2560 COLORADO BLVD
Second Line :
City : EAGLE ROCK
State : CA
Zip : 90041-1005
Country : US
Telephone Number : 323-255-5409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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Directions to “ SUMMER ROBERTSON ATC, CSCS” Practice Location

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