MEDICARE: LAURA MELINDA RAGONESE 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	RT001963A	PA

General Provider Information

NPI Number	:	1770838385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MELINDA RAGONESE ATC

Provider Business Mailing Address
First Line	:	113 MAPLE LN
Second Line	:
City	:	NEWFOUNDLAND
State	:	PA
Zip	:	18445-2221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2552 ROUTE 6
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-7045
Country	:	US
Telephone Number	:	570-226-4557
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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