MEDICARE: MRS. DAWN THERESA GABRICH MS, 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	36000901A	IN

General Provider Information

NPI Number	:	1356324339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN THERESA GABRICH MS, ATC

Provider Business Mailing Address
First Line	:	13001 NUTMEG RIDGE DR
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-8593
Country	:	US
Telephone Number	:	574-941-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 PROVIDENT DR
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3291
Country	:	US
Telephone Number	:	574-372-7671
Fax Number	:	574-372-7625

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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