MEDICARE: MR. JOHN MORGAN KALTENBORN MS, ATC, PES

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		VA

General Provider Information

NPI Number	:	1730124553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MORGAN KALTENBORN MS, ATC, PES

Provider Business Mailing Address
First Line	:	JAMES MADISON UNIVERSITY
Second Line	:	MSC 2301 GODWIN HALL RM. 128
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-0001
Country	:	US
Telephone Number	:	540-568-8020
Fax Number	:	540-568-6950

Provider Business Practice Location Address
First Line	:	JAMES MADISON UNIVERSITY
Second Line	:	MSC 2301 GODWIN HALL RM. 128
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-0001
Country	:	US
Telephone Number	:	540-568-8020
Fax Number	:	540-568-6950

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	04/14/2015

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