MEDICARE: JOHN DEBILZAN 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	089	KY

General Provider Information

NPI Number	:	1174938021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DEBILZAN ATC

Provider Business Mailing Address
First Line	:	474 OSPREY CIR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-4356
Country	:	US
Telephone Number	:	859-420-4135
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 OSPREY CIR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-4356
Country	:	US
Telephone Number	:	859-420-4135
Fax Number	:

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

Provider Enumeration Date	:	06/29/2014
Last Update Date	:	06/29/2014

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