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General NPI Number Information
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NPI Number | 1205176385
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Entity Type | Individual
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Provider Name | STEPHANIE ANN CROSBY MAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 5565 S 700 E
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City | WHITESTOWN
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State | IN
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Zip | 46075-9370
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Country | US
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Telephone | 317-873-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 8227 NORTHWEST BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1387
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 39001944A
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License Number State | IN
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