Alex Edward Boron-Magulick
Individual provider Active NPI Athletic Trainer · Emory, VA
NPI 1295337020 · NPPES record last updated Nov 16, 2020
Key facts
- NPI
- 1295337020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 12228 Itta Bena Road
Emory, VA 24327 - Phone
- (276) 944-6928
- NPI assigned
- Nov 16, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
12228 Itta Bena Road
Emory, VA 24327
Mailing address
PO Box 947
Emory, VA 24327-0947
Other providers in Emory, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.