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NPI Code Detail

MEDICARE: ALYSSA NELLE PLANTZ ATC

MEDICARE: ALYSSA NELLE PLANTZ 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
12255A2300XAthletic TrainerAT-004804OH

General Provider Information

NPI Number : 1538653522
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA NELLE PLANTZ ATC
Provider Business Mailing Address
First Line : 300 COLLEGE PARK AVE
Second Line :
City : DAYTON
State : OH
Zip : 45469-0002
Country : US
Telephone Number : 615-973-8860
Fax Number :
Provider Business Practice Location Address
First Line : 300 COLLEGE PARK AVE
Second Line :
City : DAYTON
State : OH
Zip : 45469-0002
Country : US
Telephone Number : 615-973-8860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 06/21/2018

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Directions to “ ALYSSA NELLE PLANTZ ATC” Practice Location

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