MEDICARE: JASON HEATH ROBEY MS, LAT, 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	1315	NC

General Provider Information

NPI Number	:	1568589307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON HEATH ROBEY MS, LAT, ATC

Provider Business Mailing Address
First Line	:	111 TATER HILL ESTATES DR
Second Line	:	APT 2
City	:	BOONE
State	:	NC
Zip	:	28607-9384
Country	:	US
Telephone Number	:	757-871-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	APPALACHIAN STATE UNIVERSITY
Second Line	:	135 JACK BRANCH DR.
City	:	BOONE
State	:	NC
Zip	:	28608-0001
Country	:	US
Telephone Number	:	828-262-6265
Fax Number	:	828-262-7099

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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