MEDICARE: JULIA AUDREY GASSE 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	AL6954	FL

General Provider Information

NPI Number	:	1548930589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA AUDREY GASSE MS, LAT, ATC

Provider Business Mailing Address
First Line	:	8708 W HILLSBOROUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8708 W HILLSBOROUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3719
Country	:	US
Telephone Number	:	703-380-4478
Fax Number	:

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

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	07/25/2024

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