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NPI Code Detail

MEDICARE: MR. SCOTT PIEHL ATC, CSCS

MEDICARE: MR. SCOTT PIEHL ATC, 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
12255A2300XAthletic Trainer96001604IL

General Provider Information

NPI Number : 1457348013
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT PIEHL ATC, CSCS
Provider Business Mailing Address
First Line : 2022 ARBOR FALLS DR
Second Line :
City : PLAINFIELD
State : IL
Zip : 60586-5736
Country : US
Telephone Number : 773-284-6735
Fax Number :
Provider Business Practice Location Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/08/2007

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