=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851614929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP LOUIS FRANK M.S., A.T.C., C.E.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2010
-----------------------------------------------------
Last Update Date | 03/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 LEWIS CENTER RD
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-9049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-657-4181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3262 BROOKVIEW WAY
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43221-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-657-4181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT-2720
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------