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General NPI Number Information
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NPI Number | 1316796667
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Entity Type | Organization
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Legal Business Name | NEURO ACTIVE
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 164 TROUT POND LN
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City | BANNER ELK
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State | NC
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Zip | 28604-8689
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Country | US
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Telephone | 828-896-7803
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Fax |
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Provider Business Mailing Address
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Address Line | 164 TROUT POND LN
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City | BANNER ELK
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State | NC
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Zip | 28604-8689
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Country | US
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Telephone | 828-896-7803
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Fax |
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Authorized Official
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Title or Position | OWNER/ATHLETIC TRAINER
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Name | DR. ASHLEY SWEENEY LONG
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Credential | PHD, LAT, ATC, CBIS
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Telephone | 828-896-7803
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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 |
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License Number State |
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