MEDICARE: STEPHEN WAYNE WESTFALL ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL3365	FL

General Provider Information

NPI Number	:	1134926470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN WAYNE WESTFALL ATC

Provider Business Mailing Address
First Line	:	3405 CITATION DR
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-5208
Country	:	US
Telephone Number	:	585-610-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 CITATION DR
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-5208
Country	:	US
Telephone Number	:	585-610-9188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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