MEDICARE: SYRENA DAWN SPANBURGH-HESS LAT, 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	1770	SC
2	2255A2300X	Athletic Trainer	RT006156	PA

General Provider Information

NPI Number	:	1932551199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYRENA DAWN SPANBURGH-HESS LAT, ATC

Provider Business Mailing Address
First Line	:	340 OAKWOOD DR
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-7216
Country	:	US
Telephone Number	:	484-547-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1162 EDEN TER
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3208
Country	:	US
Telephone Number	:	803-323-2129
Fax Number	:	803-323-3933

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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