MEDICARE: MR. PETER KRYSKO MED, LATC

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	1114	MA

General Provider Information

NPI Number	:	1003497033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER KRYSKO MED, LATC

Provider Business Mailing Address
First Line	:	2 MORSE DR
Second Line	:
City	:	NORTON
State	:	MA
Zip	:	02766-2823
Country	:	US
Telephone Number	:	978-618-5418
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WASHINGTON ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02357-0001
Country	:	US
Telephone Number	:	508-565-1514
Fax Number	:

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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