Healthcare Provider Details

I. General information

NPI: 1407890486
Provider Name (Legal Business Name): MATTHEW REUSS STUMPF MA, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42278 DEBORAH DR
HAMMOND LA
70403-7655
US

IV. Provider business mailing address

42278 DEBORAH DR
HAMMOND LA
70403-7655
US

V. Phone/Fax

Practice location:
  • Phone: 225-572-8099
  • Fax: 225-572-8099
Mailing address:
  • Phone: 225-572-8099
  • Fax: 225-572-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: