Healthcare Provider Details

I. General information

NPI: 1316311145
Provider Name (Legal Business Name): KALA YOUNG ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MTSU SPORTS MEDICINE DEPARTMENT 2650 MIDDLE TENNESSEE BLVD
MURFREESBORO TN
37132-0001
US

IV. Provider business mailing address

MTSU SPORTS MEDICINE DEPARTMENT MURPHY CTR P.O BOX 77
MURFREESBORO TN
37132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 540-908-1578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1960
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: