MEDICARE: MORGAN ELIZABETH BENNETT 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	25MT00219900	NJ
2	2255A2300X	Athletic Trainer	36002441A	IN

General Provider Information

NPI Number	:	1164880126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN ELIZABETH BENNETT ATC

Provider Business Mailing Address
First Line	:	51 WESLEY LN
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-4249
Country	:	US
Telephone Number	:	609-234-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 WESLEY LN
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-4249
Country	:	US
Telephone Number	:	609-234-4557
Fax Number	:

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

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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