MEDICARE: MONIQUE TESTA MS, LAT, ATC, PES

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	RT005452	PA

General Provider Information

NPI Number	:	1811380272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE TESTA MS, LAT, ATC, PES

Provider Business Mailing Address
First Line	:	218 HANKEY FARMS DR
Second Line	:
City	:	OAKDALE
State	:	PA
Zip	:	15071-9306
Country	:	US
Telephone Number	:	412-809-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 KELTON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2421
Country	:	US
Telephone Number	:	412-571-6022
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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