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NPI Code Detail

MEDICARE: JUSTIN ANNIN ATC

MEDICARE:   JUSTIN  ANNIN  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
12255A2300XAthletic Trainer608NE

General Provider Information

NPI Number : 1528519923
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN ANNIN ATC
Provider Business Mailing Address
First Line : 12419 S 79TH AVE
Second Line :
City : PAPILLION
State : NE
Zip : 68046-4694
Country : US
Telephone Number : 402-991-9792
Fax Number :
Provider Business Practice Location Address
First Line : 12419 S 79TH AVE
Second Line :
City : PAPILLION
State : NE
Zip : 68046-4694
Country : US
Telephone Number : 402-991-9792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2016
Last Update Date : 10/20/2016

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Directions to “ JUSTIN ANNIN ATC” Practice Location

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