MEDICARE: MR. PERRY DAVID DENEHY AT

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	AT271	OH
2	2255A2300X	Athletic Trainer	AT-271	OH

General Provider Information

NPI Number	:	1336101658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERRY DAVID DENEHY AT

Provider Business Mailing Address
First Line	:	500 E BUSINESS WAY
Second Line	:
City	:	SHARONVILLE
State	:	OH
Zip	:	45241
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-489-7425

Provider Business Practice Location Address
First Line	:	500 E BUSINESS WAY
Second Line	:
City	:	SHARONVILLE
State	:	OH
Zip	:	45241
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-489-7425

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	09/14/2018

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