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General NPI Number Information
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NPI Number | 1508443524
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Entity Type | Individual
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Provider Name | KATHLEEN RYAN LALONDE ATC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 11911 CLINTON RIVER RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-2420
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Country | US
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Telephone | 586-797-1653
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Fax |
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Provider Business Mailing Address
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Address Line | 3466 YARNEY RD
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City | WATERFORD
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State | MI
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Zip | 48329-2780
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Country | US
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Telephone | 248-302-6372
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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 | 2000000907
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001181
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License Number State | MI
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