MEDICARE: MRS. JESSICA NICOLE SOBIE MS, ATC, LAT

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	AT.0001017	CO

General Provider Information

NPI Number	:	1447224266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA NICOLE SOBIE MS, ATC, LAT

Provider Business Mailing Address
First Line	:	225 INDIAN PEAKS DR
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-2645
Country	:	US
Telephone Number	:	303-947-3370
Fax Number	:	720-848-8204

Provider Business Practice Location Address
First Line	:	2000 S COLORADO BLVD STE 1-4500
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7911
Country	:	US
Telephone Number	:	720-848-8255
Fax Number	:	720-848-8204

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/21/2022

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