MEDICARE: AARON GODBOUT 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	AT.0001264	CO

General Provider Information

NPI Number	:	1538675657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON GODBOUT ATC

Provider Business Mailing Address
First Line	:	5406 HIMALAYA CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7585
Country	:	US
Telephone Number	:	218-343-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S SABLE BLVD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4631
Country	:	US
Telephone Number	:	303-755-7160
Fax Number	:

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

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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