MEDICARE: MR. CHRIS GADAH 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	AL2346	FL

General Provider Information

NPI Number	:	1457960312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS GADAH ATC, LAT

Provider Business Mailing Address
First Line	:	2202 PEARL CIDER ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4483
Country	:	US
Telephone Number	:	941-284-4721
Fax Number	:

Provider Business Practice Location Address
First Line	:	12340 BOGGY CREEK RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-6902
Country	:	US
Telephone Number	:	941-284-4721
Fax Number	:

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

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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