MEDICARE: URIAH MYRIE 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	002197	NY

General Provider Information

NPI Number	:	1164838330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URIAH MYRIE ATC

Provider Business Mailing Address
First Line	:	403 GREENHILL CT
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-5618
Country	:	US
Telephone Number	:	518-577-7524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 NRG PARK
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1573
Country	:	US
Telephone Number	:	832-667-2301
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/21/2022

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