MEDICARE: PAIGE P AHART ATC

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	AL3794	FL

General Provider Information

NPI Number	:	1073981429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE P AHART ATC

Provider Business Mailing Address
First Line	:	638 VINE AVE
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-7819
Country	:	US
Telephone Number	:	712-269-5826
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 GYPSUM LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-5338
Country	:	US
Telephone Number	:	712-269-5826
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	05/12/2016

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Directions to “ PAIGE P AHART ATC” Practice Location

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