MEDICARE: DONALD J KRON ATC, LAT

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	ATHJ00052	LA

General Provider Information

NPI Number	:	1912110339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD J KRON ATC, LAT

Provider Business Mailing Address
First Line	:	2713 MYRTLE GROVE LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4002
Country	:	US
Telephone Number	:	337-474-6651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2713 MYRTLE GROVE LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4002
Country	:	US
Telephone Number	:	337-474-6651
Fax Number	:

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

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

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