MEDICARE: ELIZABETH MEDVIN MA, 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

General Provider Information

NPI Number	:	1538537204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MEDVIN MA, LAT, ATC

Provider Business Mailing Address
First Line	:	6501 TANGLEWOOD LN
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-3146
Country	:	US
Telephone Number	:	216-973-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 UNIVERSITY SQ
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16541-2632
Country	:	US
Telephone Number	:	216-973-4342
Fax Number	:

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

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	08/09/2021

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