MEDICARE: CHRISTOPHER B PARKER ATC, EMT-B

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	RT005067	PA

General Provider Information

NPI Number	:	1366726929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER B PARKER ATC, EMT-B

Provider Business Mailing Address
First Line	:	401 JAMISON AVE
Second Line	:	APT. B
City	:	ELLWOOD CITY
State	:	PA
Zip	:	16117-2566
Country	:	US
Telephone Number	:	724-601-4699
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PROSPECT ST
Second Line	:	EAST STROUDSBURG UNIVERSITY
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-2956
Country	:	US
Telephone Number	:	724-601-4699
Fax Number	:

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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