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NPI Code Detail

MEDICARE: STEVE R DELONG MS ATC

MEDICARE: STEVE R DELONG MS 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 TrainerWA

General Provider Information

NPI Number : 1699858613
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVE R DELONG MS ATC
Provider Business Mailing Address
First Line : 502 E BOONE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99258-1774
Country : US
Telephone Number : 509-323-4205
Fax Number : 509-323-5789
Provider Business Practice Location Address
First Line : 502 E BOONE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99258-1774
Country : US
Telephone Number : 509-323-4205
Fax Number : 509-323-5789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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