Healthcare Provider Details

I. General information

NPI: 1881094514
Provider Name (Legal Business Name): LORAN STRUNK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DOG BRANCH RD
EAST PALATKA FL
32131-4162
US

IV. Provider business mailing address

PO BOX 1183
EAST PALATKA FL
32131-1183
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-3630
  • Fax:
Mailing address:
  • Phone: 386-328-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberSC034984
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: