MEDICARE: MR. BRADFORD C SKIFF M.S., A.T.C.

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	AL 1962	FL

General Provider Information

NPI Number	:	1790822666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADFORD C SKIFF M.S., A.T.C.

Provider Business Mailing Address
First Line	:	13138 HIDDEN BEACH WAY
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5914
Country	:	US
Telephone Number	:	321-221-0389
Fax Number	:

Provider Business Practice Location Address
First Line	:	13138 HIDDEN BEACH WAY
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5914
Country	:	US
Telephone Number	:	321-221-0389
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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