Healthcare Provider Details

I. General information

NPI: 1659849461
Provider Name (Legal Business Name): CATHERINE LOUISE LEBRYK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9042 COLUMBIA AVE STE B
MUNSTER IN
46321-2928
US

IV. Provider business mailing address

8202 EUCLID AVE
MUNSTER IN
46321-1708
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-4461
  • Fax: 219-703-6660
Mailing address:
  • Phone: 219-836-8332
  • Fax:

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: