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NPI Code Detail

MEDICARE: MRS. LAURA DARBY MCNALLY ATC

MEDICARE: MRS. LAURA DARBY MCNALLY 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
12255A2300XAthletic Trainer300MA

General Provider Information

NPI Number : 1962438085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA DARBY MCNALLY ATC
Provider Business Mailing Address
First Line : 1400 LOWELL RD
Second Line :
City : CONCORD
State : MA
Zip : 01742-5210
Country : US
Telephone Number : 978-369-4688
Fax Number :
Provider Business Practice Location Address
First Line : 1400 LOWELL RD
Second Line :
City : CONCORD
State : MA
Zip : 01742-5210
Country : US
Telephone Number : 978-369-4688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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