Provider Demographics
NPI:1881000289
Name:HERRENBRUCK, STEVEN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:HERRENBRUCK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BRYAN STATION RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2138
Mailing Address - Country:US
Mailing Address - Phone:812-202-1038
Mailing Address - Fax:270-926-4003
Practice Address - Street 1:1650 BRYAN STATION RD
Practice Address - Street 2:SUITE 122
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2138
Practice Address - Country:US
Practice Address - Phone:859-293-6133
Practice Address - Fax:859-293-6730
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT10182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer