MEDICARE: SARA L MYERS ATC, LAT, CSCS

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	36000695A	IN

General Provider Information

NPI Number	:	1396727103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA L MYERS ATC, LAT, CSCS

Provider Business Mailing Address
First Line	:	201 PENNSYLVANIA PKWY
Second Line	:	STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-1393
Country	:	US
Telephone Number	:	317-817-1200
Fax Number	:	317-817-1220

Provider Business Practice Location Address
First Line	:	201 PENNSYLVANIA PKWY
Second Line	:	STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-1393
Country	:	US
Telephone Number	:	317-817-1200
Fax Number	:	317-817-1220

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/03/2016

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