MEDICARE: MR. GERALD EDWARD RISHEL A.T.,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	2255A2300X	Athletic Trainer	AT000130	OH

General Provider Information

NPI Number	:	1992769392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD EDWARD RISHEL A.T.,C.

Provider Business Mailing Address
First Line	:	1404 DIFFORD DR
Second Line	:
City	:	NILES
State	:	OH
Zip	:	44446-2843
Country	:	US
Telephone Number	:	330-652-5209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6204
Country	:	US
Telephone Number	:	330-394-8282
Fax Number	:	330-394-6931

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/08/2007

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