Healthcare Provider Details

I. General information

NPI: 1033232756
Provider Name (Legal Business Name): KIRK JOHN ARMSTRONG ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BALL STATE UNIVESITY 2000 W. UNIVERSITY BLVD
MUNCIE IN
47306-0001
US

IV. Provider business mailing address

1801 N FOREST AVE
MUNCIE IN
47304-2517
US

V. Phone/Fax

Practice location:
  • Phone: 765-285-5039
  • Fax: 765-282-8254
Mailing address:
  • Phone: 765-729-5012
  • Fax: 765-285-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000893A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: