Provider Demographics
NPI:1881094514
Name:STRUNK, LORAN (ATC)
Entity type:Individual
Prefix:
First Name:LORAN
Middle Name:
Last Name:STRUNK
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:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-1183
Mailing Address - Country:US
Mailing Address - Phone:386-328-3630
Mailing Address - Fax:
Practice Address - Street 1:121 DOG BRANCH RD
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4162
Practice Address - Country:US
Practice Address - Phone:386-328-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0349842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer