MEDICARE: MR. AARON BROSSETT ATC/L

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

General Provider Information

NPI Number	:	1013970011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AARON BROSSETT ATC/L

Provider Business Mailing Address
First Line	:	186 SPRINGBROOK TRAIL SOUTH
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-4004
Country	:	US
Telephone Number	:	630-730-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 ROUTE 71
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7416
Country	:	US
Telephone Number	:	630-554-7815
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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