MEDICARE: MISS SUZANNE MARIE STRONG 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	AT990	KY
2	2255A2300X	Athletic Trainer	1127	TN

General Provider Information

NPI Number	:	1700085495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SUZANNE MARIE STRONG ATC

Provider Business Mailing Address
First Line	:	15322 ROYAL TROON AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-6128
Country	:	US
Telephone Number	:	502-333-2087
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 GOLDSMITH LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2314
Country	:	US
Telephone Number	:	502-333-2087
Fax Number	:

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/01/2014

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