MEDICARE: MR. MICHAEL FRANCIS FLEMING JR. MS, LAT, ATC, CSCS,

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	RT004137	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RT004137	OTHER	PA	PROVIDER CODE 22

General Provider Information

NPI Number	:	1851821821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FRANCIS FLEMING JR. MS, LAT, ATC, CSCS,

Provider Business Mailing Address
First Line	:	7369 WOODLAND DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-8623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7369 WOODLAND DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-8623
Country	:	US
Telephone Number	:	717-600-7621
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	06/13/2017

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