MEDICARE: MR. SAMUEL DAVID LUNT M.S., A.T.C., L.A.T.

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	AL 224	FL

General Provider Information

NPI Number	:	1649229162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL DAVID LUNT M.S., A.T.C., L.A.T.

Provider Business Mailing Address
First Line	:	9093 COPPERFAIR LN
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32317-8196
Country	:	US
Telephone Number	:	850-878-8125
Fax Number	:	850-644-6223

Provider Business Practice Location Address
First Line	:	9093 COPPERFAIR LN
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32317-8196
Country	:	US
Telephone Number	:	850-878-8125
Fax Number	:	850-644-6223

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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