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General NPI Number Information
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NPI Number | 1972744324
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Entity Type | Individual
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Provider Name | CATHERINE CAMBIA ELLIS ATC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 217 STEWART STADIUM
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City | MURRAY
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State | KY
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Zip | 42071-3351
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Country | US
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Telephone | 270-809-5580
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Fax | 270-809-5526
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Provider Business Mailing Address
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Address Line | 313 N 6TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2018
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Country | US
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Telephone | 270-293-0587
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Fax | 270-809-5526
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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 | AT628
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License Number State | KY
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