MEDICARE: JENNIFER RONEY ATC-L

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	7116327-4810	UT

General Provider Information

NPI Number	:	1568881456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RONEY ATC-L

Provider Business Mailing Address
First Line	:	1246 E CRYSTAL AVE APT B
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2739
Country	:	US
Telephone Number	:	610-930-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1246 E CRYSTAL AVE APT B
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2739
Country	:	US
Telephone Number	:	610-930-8589
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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Directions to “ JENNIFER RONEY ATC-L” Practice Location

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