Healthcare Provider Details

I. General information

NPI: 1215374319
Provider Name (Legal Business Name): MR. KURT MONEYSMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13608 WILSON RD
UNION CITY OH
45390-9603
US

IV. Provider business mailing address

13608 WILSON RD
UNION CITY OH
45390-9603
US

V. Phone/Fax

Practice location:
  • Phone: 937-621-2275
  • Fax:
Mailing address:
  • Phone: 937-621-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number.003554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: