MEDICARE: ASHLEY MUSICK ATC, EMT

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

General Provider Information

NPI Number	:	1427409077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MUSICK ATC, EMT

Provider Business Mailing Address
First Line	:	1000 E VICTORIA ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90747-0001
Country	:	US
Telephone Number	:	310-243-2492
Fax Number	:	310-516-3710

Provider Business Practice Location Address
First Line	:	1000 E VICTORIA ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90747-0001
Country	:	US
Telephone Number	:	310-243-2492
Fax Number	:	310-516-3710

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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