MEDICARE: ROGER SANCHO MS, ATC, LAT, 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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1528519667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER SANCHO MS, ATC, LAT, CSCS

Provider Business Mailing Address
First Line	:	844 COUNTY ROAD 4764
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-0354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	844 COUNTY ROAD 4764
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-0354
Country	:	US
Telephone Number	:	903-438-6075
Fax Number	:

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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