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General NPI Number Information
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NPI Number | 1437766185
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Entity Type | Individual
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Provider Name | KATY ANGELINA MEDFORD MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2020
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | C-8247 ARDENNES STREET
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 870-833-2352
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Fax |
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Provider Business Mailing Address
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Address Line | 711 PIPER FARM RD APT 2
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-6603
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Country | US
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Telephone | 870-833-2352
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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 | 2430
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License Number State | AL
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