MEDICARE: EMILY ROSAK

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NO INSURANCE

General Provider Information

NPI Number	:	1578139176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ROSAK

Provider Business Mailing Address
First Line	:	4887 MEADOWVIEW TER
Second Line	:
City	:	ZIONSVILLE
State	:	PA
Zip	:	18092-2060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4887 MEADOWVIEW TER
Second Line	:
City	:	ZIONSVILLE
State	:	PA
Zip	:	18092-2060
Country	:	US
Telephone Number	:	610-390-6856
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ EMILY ROSAK ” Practice Location

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