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NPI Code Detail

MEDICARE: MICHELLE SUSAN VARNELL ATC

MEDICARE: MICHELLE SUSAN VARNELL ATC
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
12255A2300XAthletic Trainer0543AZ

General Provider Information

NPI Number : 1033181714
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE SUSAN VARNELL ATC
Provider Business Mailing Address
First Line : 4101 E BASELINE RD
Second Line : #1433
City : GILBERT
State : AZ
Zip : 85234-9101
Country : US
Telephone Number : 602-463-9605
Fax Number :
Provider Business Practice Location Address
First Line : 4710 N 5TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1738
Country : US
Telephone Number : 602-240-3119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 07/08/2007

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Directions to “ MICHELLE SUSAN VARNELL ATC” Practice Location

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