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NPI Code Detail

MEDICARE: ANGELA PERUSEK

MEDICARE: ANGELA PERUSEK
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 Trainer002608OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122OTHEROHATHLETIC TRAINER

General Provider Information

NPI Number : 1659403236
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA PERUSEK
Provider Business Mailing Address
First Line : 114 ANDERSON FERRY RD
Second Line : APT 89
City : CINCINNATI
State : OH
Zip : 45238-5960
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5701 DELHI RD
Second Line : HEALTH SCIENCE DEPARTMENT
City : CINCINNATI
State : OH
Zip : 45233-1669
Country : US
Telephone Number : 513-244-4529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2007
Last Update Date : 07/08/2007

Similar Medicare Providers

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Directions to “ ANGELA PERUSEK ” Practice Location

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