MEDICARE: NATIONAL ATHLETIC HEALTH CARE ALLIANCE, P.C.

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	2251X0800X	Orthopedic Physical Therapist	1729	CT

General Provider Information

NPI Number	:	1861483661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL ATHLETIC HEALTH CARE ALLIANCE, P.C.

Provider Business Mailing Address
First Line	:	3955 W RAVENGUARD RD
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-4312
Country	:	US
Telephone Number	:	928-636-9053
Fax Number	:	928-636-2270

Provider Business Practice Location Address
First Line	:	410 MOREHOUSE RD
Second Line	:
City	:	EASTON
State	:	CT
Zip	:	06612-1638
Country	:	US
Telephone Number	:	928-636-9053
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CYNTHIA VENTRICELLI
Credential	:
Telephone Number	:	928-636-9053

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2020

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