MEDICARE: MS. STEPHANIE LYNN FLOOR

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

General Provider Information

NPI Number	:	1609590678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE LYNN FLOOR

Provider Business Mailing Address
First Line	:	PMB 1222,
Second Line	:	109 UNIVERSITY SQUARE
City	:	ERIE
State	:	PA
Zip	:	16541
Country	:	US
Telephone Number	:	845-648-0589
Fax Number	:

Provider Business Practice Location Address
First Line	:	PMB 1222,
Second Line	:	109 UNIVERSITY SQUARE
City	:	ERIE
State	:	PA
Zip	:	16541
Country	:	US
Telephone Number	:	845-648-0589
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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