MEDICARE: MS. CARA ANN DESALVO 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	RT003188	PA

General Provider Information

NPI Number	:	1730174178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARA ANN DESALVO ATC

Provider Business Mailing Address
First Line	:	3204 JANE ST
Second Line	:	APT 1
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2537
Country	:	US
Telephone Number	:	412-481-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S WATER ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2307
Country	:	US
Telephone Number	:	412-432-3700
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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