MEDICARE: JOSHUEL IRIZARRY

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	RT005389	PA

General Provider Information

NPI Number	:	1124456843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUEL IRIZARRY

Provider Business Mailing Address
First Line	:	2181 VILLAGE RD
Second Line	:
City	:	EFFORT
State	:	PA
Zip	:	18330-7750
Country	:	US
Telephone Number	:	787-981-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2181 VILLAGE RD
Second Line	:
City	:	EFFORT
State	:	PA
Zip	:	18330-7750
Country	:	US
Telephone Number	:	787-981-7041
Fax Number	:

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

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	10/15/2013

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Directions to “ JOSHUEL IRIZARRY ” Practice Location

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