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NPI Code Detail

MEDICARE: TRUC LY

MEDICARE: TRUC LY
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 TrainerNY

General Provider Information

NPI Number : 1366378101
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRUC LY
Provider Business Mailing Address
First Line : 348 SPRUCEWOOD TER
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-3938
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3925 SHERIDAN DR
Second Line :
City : AMHERST
State : NY
Zip : 14226-1738
Country : US
Telephone Number : 716-250-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2026
Last Update Date : 06/19/2026

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Directions to “ TRUC LY ” Practice Location

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