MEDICARE: ANDREA FETZER ATC

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		CO

General Provider Information

NPI Number	:	1508274036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA FETZER ATC

Provider Business Mailing Address
First Line	:	1995 S DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 S COLORADO BLVD
Second Line	:	SUITE 1-4500
City	:	DENVER
State	:	CO
Zip	:	80222-7900
Country	:	US
Telephone Number	:	720-848-8200
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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