MEDICARE: MS. CARISA MARIA RAUCCI 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
1	2255A2300X	Athletic Trainer	AT3133	TX

General Provider Information

NPI Number	:	1316081573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARISA MARIA RAUCCI ATC, LAT

Provider Business Mailing Address
First Line	:	12700 FM 1960 RD W
Second Line	:	#14104
City	:	HOUSTON
State	:	TX
Zip	:	77065-5340
Country	:	US
Telephone Number	:	210-867-0279
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 SOLOMON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-2134
Country	:	US
Telephone Number	:	713-896-3432
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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