MEDICARE: MR. PETER CERENZO MS, LAT, ATC, CES

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	RT007030	PA

General Provider Information

NPI Number	:	1972202398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER CERENZO MS, LAT, ATC, CES

Provider Business Mailing Address
First Line	:	6012 WASHINGTON LN
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-2436
Country	:	US
Telephone Number	:	609-217-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	6012 WASHINGTON LN
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-2436
Country	:	US
Telephone Number	:	609-217-1522
Fax Number	:

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

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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