Healthcare Provider Details

I. General information

NPI: 1124107636
Provider Name (Legal Business Name): NANCY A FURCSIK MA, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S 11TH ST
CHESTERTON IN
46304-8934
US

IV. Provider business mailing address

2125 S 11TH ST
CHESTERTON IN
46304-8934
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-3759
  • Fax: 219-983-3771
Mailing address:
  • Phone: 219-983-3759
  • Fax: 219-983-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: