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General NPI Number Information
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NPI Number | 1649229162
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Entity Type | Individual
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Provider Name | SAMUEL DAVID LUNT M.S., A.T.C., L.A.T.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9093 COPPERFAIR LN
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City | TALLAHASSEE
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State | FL
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Zip | 32317-8196
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Country | US
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Telephone | 850-878-8125
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Fax | 850-644-6223
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Provider Business Mailing Address
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Address Line | 9093 COPPERFAIR LN
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City | TALLAHASSEE
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State | FL
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Zip | 32317-8196
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Country | US
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Telephone | 850-878-8125
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Fax | 850-644-6223
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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 | AL 224
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License Number State | FL
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