Provider Demographics
NPI:1083045603
Name:SAFRAOUI, SAMYRA (ATC)
Entity Type:Individual
Prefix:
First Name:SAMYRA
Middle Name:
Last Name:SAFRAOUI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LANCASTER AVE
Mailing Address - Street 2:MOBERLY BUILDING - ATHLETIC TRAINING
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3100
Mailing Address - Country:US
Mailing Address - Phone:859-622-2140
Mailing Address - Fax:859-622-8857
Practice Address - Street 1:521 LANCASTER AVE
Practice Address - Street 2:MOBERLY BUILDING - ATHLETIC TRAINING
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3100
Practice Address - Country:US
Practice Address - Phone:859-622-2140
Practice Address - Fax:859-622-8857
Is Sole Proprietor?:No
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT10342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer