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NPI Code Detail

MEDICARE: MICHAEL L LANDSBERG ATC

MEDICARE: MICHAEL L LANDSBERG 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
12255A2300XAthletic Trainer104-0000019VT

General Provider Information

NPI Number : 1902891708
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL L LANDSBERG ATC
Provider Business Mailing Address
First Line : 70 BRICKYARD RD
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-4346
Country : US
Telephone Number : 802-872-0027
Fax Number : 802-861-2812
Provider Business Practice Location Address
First Line : 30 HAWTHORNE ST
Second Line :
City : WILLISTON
State : VT
Zip : 05495-8212
Country : US
Telephone Number : 802-861-0111
Fax Number : 802-861-2812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 08/27/2009

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Directions to “ MICHAEL L LANDSBERG ATC” Practice Location

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