Provider Demographics
NPI:1730595737
Name:LONG, MARGARET (MS,LAT, ATC, PES)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MS,LAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W LAKE ST APT A
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-1430
Mailing Address - Country:US
Mailing Address - Phone:219-810-7935
Mailing Address - Fax:
Practice Address - Street 1:3201 STANLEY ST
Practice Address - Street 2:APT. C
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9267
Practice Address - Country:US
Practice Address - Phone:219-810-7935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer