Healthcare Provider Details

I. General information

NPI: 1114381829
Provider Name (Legal Business Name): REBECCA STRAUB ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FAIRVIEW AVE
ANDOVER NY
14806-9310
US

IV. Provider business mailing address

10 UPPER COLLEGE DR
ALFRED NY
14802-1153
US

V. Phone/Fax

Practice location:
  • Phone: 716-307-7995
  • Fax:
Mailing address:
  • Phone: 607-587-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: