MEDICARE: JULIE BROUGH AT

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-2686	OH

General Provider Information

NPI Number	:	1568830370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE BROUGH AT

Provider Business Mailing Address
First Line	:	3552 NORTHCLIFFE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3667
Country	:	US
Telephone Number	:	307-760-7926
Fax Number	:

Provider Business Practice Location Address
First Line	:	3552 NORTHCLIFFE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3667
Country	:	US
Telephone Number	:	307-760-7926
Fax Number	:

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

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

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