MEDICARE: ALLISON BIRD 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	2000013482

General Provider Information

NPI Number	:	1245678895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON BIRD ATC

Provider Business Mailing Address
First Line	:	4990 TULIP GROVE RD
Second Line	:
City	:	GREEN SEA
State	:	SC
Zip	:	29545-4977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 TULIP GROVE RD
Second Line	:
City	:	GREEN SEA
State	:	SC
Zip	:	29545-4977
Country	:	US
Telephone Number	:	843-392-3131
Fax Number	:

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	01/29/2016

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Directions to “ ALLISON BIRD ATC” Practice Location

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