Provider Demographics
NPI:1023203908
Name:TRULOCK, SCOTT COLLINS (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:COLLINS
Last Name:TRULOCK
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EVERBANK FIELD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-1928
Mailing Address - Country:US
Mailing Address - Phone:904-633-6566
Mailing Address - Fax:904-633-6070
Practice Address - Street 1:1 EVERBANK FIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1928
Practice Address - Country:US
Practice Address - Phone:904-633-6566
Practice Address - Fax:904-633-6070
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer