Healthcare Provider Details

I. General information

NPI: 1073184883
Provider Name (Legal Business Name): SYDNEY STEVELINCK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HORIZON DR
LYONS CO
80540-5016
US

IV. Provider business mailing address

PO BOX 1624
LYONS CO
80540-1624
US

V. Phone/Fax

Practice location:
  • Phone: 586-569-1378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: