MEDICARE: KENDRA VAROSKOVIC 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	LAT-5682	NC

General Provider Information

NPI Number	:	1780485227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA VAROSKOVIC LAT, ATC

Provider Business Mailing Address
First Line	:	7255 JETTY LN APT 312
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-1113
Country	:	US
Telephone Number	:	207-766-1864
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 AUTUMN HALL DR STE 220
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-2057
Country	:	US
Telephone Number	:	910-660-8018
Fax Number	:

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

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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