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NPI Code Detail

MEDICARE: MS. ROSE M SMITH ATC

MEDICARE: MS. ROSE M SMITH 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
12255A2300XAthletic Trainer
22255A2300XAthletic TrainerC03776717451854NJ

General Provider Information

NPI Number : 1770898405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROSE M SMITH ATC
Provider Business Mailing Address
First Line : 2 MICHAELS CT
Second Line :
City : CAPE MAY COURT HOUSE
State : NJ
Zip : 08210-1433
Country : US
Telephone Number : 732-713-2705
Fax Number :
Provider Business Practice Location Address
First Line : 2 MICHAELS CT
Second Line :
City : CAPE MAY COURT HOUSE
State : NJ
Zip : 08210-1433
Country : US
Telephone Number : 732-713-2705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2010
Last Update Date : 05/24/2025

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