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NPI Code Detail

MEDICARE: LARRY ROBERT ULLERY ATC

MEDICARE: LARRY ROBERT ULLERY ATC
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 TrainerAT195KY

General Provider Information

NPI Number : 1558325076
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY ROBERT ULLERY ATC
Provider Business Mailing Address
First Line : 3817 KITTIWAKE DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-3835
Country : US
Telephone Number : 859-245-0768
Fax Number :
Provider Business Practice Location Address
First Line : 601 PERIMETER DR
Second Line : SUITE 200
City : LEXINGTON
State : KY
Zip : 40517-4121
Country : US
Telephone Number : 859-323-5533
Fax Number : 859-257-0168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 01/19/2010

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Directions to “ LARRY ROBERT ULLERY ATC” Practice Location

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