MEDICARE: ASHLEY COX MS, LAT, 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	RT006500	PA

General Provider Information

NPI Number	:	1255805677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY COX MS, LAT, ATC

Provider Business Mailing Address
First Line	:	149 JEFFERSON DR
Second Line	:
City	:	FAYETTE CITY
State	:	PA
Zip	:	15438-1242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 CONSTITUTION ST
Second Line	:
City	:	PERRYOPOLIS
State	:	PA
Zip	:	15473-1390
Country	:	US
Telephone Number	:	724-736-9507
Fax Number	:

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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