Samantha Bourcy, MATRG, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2634 Issued in MN

Practice address

111 17TH Ave E
Suite 101
Alexandria, MN 56308-5273

Phone

(320) 762-1144

Fax

(320) 762-1935

NPI assigned

Nov 4, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1558767483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 17TH AVE E",
            "address_2": "SUITE 101",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085273",
            "telephone_number": "320-762-1144",
            "fax_number": "320-762-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 17TH AVE E",
            "address_2": "SUITE 101",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085273",
            "telephone_number": "320-762-1144",
            "fax_number": "320-762-1935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURCY",
        "first_name": "SAMANTHA",
        "credential": "MATRG, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-04",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ND",
            "license": "503-13",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.