MEDICARE: MISS RIANE M TOLBERT A.T.C.

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	RT004136	PA

General Provider Information

NPI Number	:	1083811723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RIANE M TOLBERT A.T.C.

Provider Business Mailing Address
First Line	:	315 NICOLA LN
Second Line	:
City	:	HOCKESSIN
State	:	DE
Zip	:	19707-9191
Country	:	US
Telephone Number	:	302-250-2469
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 AUDUBON VILLAGE DR
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2262
Country	:	US
Telephone Number	:	610-676-0411
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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