MEDICARE: MICHELLE AUSTIN RAWLYK 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

General Provider Information

NPI Number	:	1114429867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE AUSTIN RAWLYK ATC

Provider Business Mailing Address
First Line	:	5310 N OCEAN BLVD UNIT 501
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2531
Country	:	US
Telephone Number	:	804-683-7363
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 N OCEAN BLVD UNIT 501
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2531
Country	:	US
Telephone Number	:	804-683-7363
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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