Healthcare Provider Details

I. General information

NPI: 1093120693
Provider Name (Legal Business Name): MICHAEL FLYNN ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

IV. Provider business mailing address

2748 SW BERKSHIRE DR
TOPEKA KS
66614-4870
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-8880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00004
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: