MEDICARE: JAMES SPENGLER 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	0126001796	VA

General Provider Information

NPI Number	:	1285980292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SPENGLER ATC

Provider Business Mailing Address
First Line	:	2643 FOUNDRY WAY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-5869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7743 VIRGINIA 7
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043
Country	:	US
Telephone Number	:	571-305-3520
Fax Number	:

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

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	07/27/2012

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