MEDICARE: MR. SCOTT P KIMBEL 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	RT001657A	PA

General Provider Information

NPI Number	:	1821062761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT P KIMBEL ATC

Provider Business Mailing Address
First Line	:	109 W CHURCH ST
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517-9242
Country	:	US
Telephone Number	:	717-587-3497
Fax Number	:	717-391-8669

Provider Business Practice Location Address
First Line	:	109 W CHURCH ST
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517-9242
Country	:	US
Telephone Number	:	717-587-3497
Fax Number	:	717-391-8669

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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