MEDICARE: STEVEN HERRENBRUCK M.S., 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	AT1018	KY

General Provider Information

NPI Number	:	1881000289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN HERRENBRUCK M.S., ATC

Provider Business Mailing Address
First Line	:	1650 BRYAN STATION RD
Second Line	:	SUITE 122
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2138
Country	:	US
Telephone Number	:	812-202-1038
Fax Number	:	270-926-4003

Provider Business Practice Location Address
First Line	:	1650 BRYAN STATION RD
Second Line	:	SUITE 122
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2138
Country	:	US
Telephone Number	:	859-293-6133
Fax Number	:	859-293-6730

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	01/12/2015

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