MEDICARE: DR. ADAM ROBERT ANNACCONE LAT, ATC, PES, CES

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	AT6699	TX

General Provider Information

NPI Number	:	1033102645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM ROBERT ANNACCONE LAT, ATC, PES, CES

Provider Business Mailing Address
First Line	:	13016 RIDGE SPRING DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-1637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13016 RIDGE SPRING DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-1637
Country	:	US
Telephone Number	:	412-337-6032
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	01/25/2020

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