Healthcare Provider Details

I. General information

NPI: 1760879803
Provider Name (Legal Business Name): KATHERINE MEYER ATC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 MAGISTERIAL DR
LOUISVILLE KY
40223-4105
US

IV. Provider business mailing address

8716 BRITTANY DR
LOUISVILLE KY
40220-5412
US

V. Phone/Fax

Practice location:
  • Phone: 800-645-5678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT807
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: