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NPI Code Detail

MEDICARE: PAIGE MANGIERO ATC LAT

MEDICARE: PAIGE MANGIERO 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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1194115766
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE MANGIERO ATC LAT
Provider Business Mailing Address
First Line : 1719 DEWES ST
Second Line :
City : GLENVIEW
State : IL
Zip : 60025-4301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1733 W GIRARD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-1513
Country : US
Telephone Number : 215-978-1972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2015
Last Update Date : 04/18/2022

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Directions to “ PAIGE MANGIERO ATC LAT” Practice Location

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