Healthcare Provider Details

I. General information

NPI: 1992734024
Provider Name (Legal Business Name): CATHERINE A SIMONSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 DR. MCKOY DRIVE CAMPBELL UNIVERSITY
BUIES CREEK NC
27506-1463
US

IV. Provider business mailing address

PO BOX 1463
BUIES CREEK NC
27506-1463
US

V. Phone/Fax

Practice location:
  • Phone: 910-814-4371
  • Fax: 910-893-1283
Mailing address:
  • Phone: 910-814-4371
  • Fax: 910-893-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: