MEDICARE: MR. ERIC MOLINA 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	AL381	FL

General Provider Information

NPI Number	:	1225067549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MOLINA ATC

Provider Business Mailing Address
First Line	:	15283 SW 172ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6777
Country	:	US
Telephone Number	:	305-233-4061
Fax Number	:

Provider Business Practice Location Address
First Line	:	15283 SW 172ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6777
Country	:	US
Telephone Number	:	305-233-4061
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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