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NPI Code Detail

MEDICARE: KIRSTIN NICOLE ANTONAROS ATC

MEDICARE: KIRSTIN NICOLE ANTONAROS 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 TrainerAT006602OH

General Provider Information

NPI Number : 1033848650
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTIN NICOLE ANTONAROS ATC
Provider Business Mailing Address
First Line : 3483 MAUTINO DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-9211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3483 MAUTINO DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-9211
Country : US
Telephone Number : 614-623-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 06/08/2022

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