MEDICARE: CASSIDY MEAGAN DEGROAT

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		FL

General Provider Information

NPI Number	:	1427682145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY MEAGAN DEGROAT

Provider Business Mailing Address
First Line	:	2160 POMEROY RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5038
Country	:	US
Telephone Number	:	727-271-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 POMEROY RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5038
Country	:	US
Telephone Number	:	727-271-7122
Fax Number	:

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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Directions to “ CASSIDY MEAGAN DEGROAT ” Practice Location

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