MEDICARE: MRS. LISA A. BRANZEL 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	AT001215	OH

General Provider Information

NPI Number	:	1811205263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA A. BRANZEL A.T.,C

Provider Business Mailing Address
First Line	:	7140 MARRISEY LOOP
Second Line	:
City	:	GALENA
State	:	OH
Zip	:	43021-7015
Country	:	US
Telephone Number	:	740-913-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 MARRISEY LOOP
Second Line	:
City	:	GALENA
State	:	OH
Zip	:	43021-7015
Country	:	US
Telephone Number	:	740-913-0101
Fax Number	:

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/16/2014

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