MEDICARE: JOSIE HARDING 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
1	2255A2300X	Athletic Trainer	1215	AZ

General Provider Information

NPI Number	:	1073934600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIE HARDING ATC

Provider Business Mailing Address
First Line	:	3800 N EL MIRAGE DR
Second Line	:	APT 4712
City	:	AVONDALE
State	:	AZ
Zip	:	85392-3843
Country	:	US
Telephone Number	:	307-256-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 E SUPERSTITION SPRINGS BLVD
Second Line	:	APT 2056
City	:	MESA
State	:	AZ
Zip	:	85206-4312
Country	:	US
Telephone Number	:	307-256-0399
Fax Number	:

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

Provider Enumeration Date	:	12/27/2013
Last Update Date	:	08/07/2014

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