MEDICARE: WAYNE RESLER JR. 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	AT2215	TX
2	2255A2300X	Athletic Trainer		TX

General Provider Information

NPI Number	:	1588702658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE RESLER JR. LAT-ATC

Provider Business Mailing Address
First Line	:	3813 O' KEEFE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-532-6780
Fax Number	:	915-532-0012

Provider Business Practice Location Address
First Line	:	3813 O' KEEFE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-532-6780
Fax Number	:	915-532-0012

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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