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NPI 1558781427

NPI 1558781427 : MICHAEL KATZ ATC : ROCHESTER, NY

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General NPI Number Information
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    NPI Number           |    1558781427
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    Entity Type          |    Individual 
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    Provider Name        |    MICHAEL KATZ ATC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    04/18/2014
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    Last Update Date     |    04/18/2014
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Provider Practice Location Address
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    Address Line         |    3690 EAST AVE 
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    City                 |    ROCHESTER
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    State                |    NY
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    Zip                  |    14618-3537
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    Country              |    US
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    Telephone            |    585-889-3745
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    Fax                  |    585-385-5221
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Provider Business Mailing Address
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    Address Line         |    3690 EAST AVE 
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    City                 |    ROCHESTER
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    State                |    NY
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    Zip                  |    14618-3537
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    Country              |    US
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    Telephone            |    585-889-3745
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    Fax                  |    585-385-5221
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    2255A2300X
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    Taxonomy Name        |    Athletic Trainer
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    License Number       |    000761
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    License Number State |    NY
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