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NPI Code Detail

MEDICARE: MS. DAWN LOUISE THRASHER ATC, NASM-PES

MEDICARE: MS. DAWN LOUISE THRASHER ATC, NASM-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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1801944574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAWN LOUISE THRASHER ATC, NASM-PES
Provider Business Mailing Address
First Line : 24710 NEW YORK ST
Second Line :
City : DEARBORN
State : MI
Zip : 48124-4484
Country : US
Telephone Number : 313-274-1907
Fax Number :
Provider Business Practice Location Address
First Line : 6525 2ND AVE
Second Line :
City : DETROIT
State : MI
Zip : 48202-3006
Country : US
Telephone Number : 313-972-4163
Fax Number : 313-972-4134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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