MEDICARE: DANIEL PREUSSER EDS, MSED, ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126001047	VA

General Provider Information

NPI Number	:	1043447063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PREUSSER EDS, MSED, ATC, LAT

Provider Business Mailing Address
First Line	:	1971 UNIVERSITY BLVD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24515-0002
Country	:	US
Telephone Number	:	434-582-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 E LAWN DR
Second Line	:	APT 302
City	:	FOREST
State	:	VA
Zip	:	24551-2983
Country	:	US
Telephone Number	:	434-426-0226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	07/27/2016

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