MEDICARE: ELLIOT JAMES DIEHL

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	3770	FL

General Provider Information

NPI Number	:	1023573367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIOT JAMES DIEHL

Provider Business Mailing Address
First Line	:	5454 N HAVERHILL RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 N HAVERHILL RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3006
Country	:	US
Telephone Number	:	408-829-5554
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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