MEDICARE: MR. DAVID P. HENZE 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	047	AL

General Provider Information

NPI Number	:	1386662120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID P. HENZE ATC

Provider Business Mailing Address
First Line	:	3435 HEATHER LN
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35216-4401
Country	:	US
Telephone Number	:	205-979-8408
Fax Number	:	205-975-7286

Provider Business Practice Location Address
First Line	:	210E BARTOW ARENA
Second Line	:	617 13TH ST SO
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0001
Country	:	US
Telephone Number	:	205-934-9040
Fax Number	:	205-975-7286

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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