MEDICARE: MS. GAIL MARIE PACE MS, 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		NC

General Provider Information

NPI Number	:	1114953551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL MARIE PACE MS, ATC

Provider Business Mailing Address
First Line	:	4642 ORLEANS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-8070
Country	:	US
Telephone Number	:	303-565-7896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4642 ORLEANS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249
Country	:	US
Telephone Number	:	303-565-7896
Fax Number	:

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	01/30/2008

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