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General NPI Number Information
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NPI Number | 1417358441
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Entity Type | Individual
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Provider Name | BENEDICT WILLIAM STOLLBERG ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 5800 AIRLINE DR
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City | METAIRIE
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State | LA
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Zip | 70003-3876
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Country | US
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Telephone | 504-733-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 537 AVENUE OF PATRIOTS ST
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City | STARKVILLE
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State | MS
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Zip | 39759-3103
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Country | US
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Telephone | 262-689-1236
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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 | AT0558
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License Number State | MS
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