MEDICARE: ELENA ANN ROBINSON DAT, LAT, 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	36002978A	IN

General Provider Information

NPI Number	:	1629560040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA ANN ROBINSON DAT, LAT, ATC

Provider Business Mailing Address
First Line	:	820 W 56TH ST APT 127
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68845-1019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 9TH AVE
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68849-4907
Country	:	US
Telephone Number	:	308-865-8014
Fax Number	:

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	09/08/2022

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