MEDICARE: DAVE A RAUCH MS, 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	AT.001067	OH

General Provider Information

NPI Number	:	1922076454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVE A RAUCH MS, ATC

Provider Business Mailing Address
First Line	:	6811 LUELDA AVE
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-1410
Country	:	US
Telephone Number	:	440-343-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	6681 RIDGE RD
Second Line	:	SUITE 102
City	:	PARMA
State	:	OH
Zip	:	44129-5713
Country	:	US
Telephone Number	:	440-743-4025
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/04/2009

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