MEDICARE: MR. JAMES J PRATT M.A., 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

General Provider Information

NPI Number	:	1255331484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES J PRATT M.A., ATC

Provider Business Mailing Address
First Line	:	1321 SALT FORK CIR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8864
Country	:	US
Telephone Number	:	517-323-7355
Fax Number	:	517-853-8822

Provider Business Practice Location Address
First Line	:	1321 SALT FORK CIR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8864
Country	:	US
Telephone Number	:	517-323-7355
Fax Number	:	517-853-8822

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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