Edward Carlisle, ATC
Individual provider Active NPI Athletic Trainer · Springboro, OH
NPI 1245649334 · NPPES record last updated Aug 4, 2014
Key facts
- NPI
- 1245649334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT.001497 (OH)
- Practice address
- 90 Remick Blvd
Springboro, OH 45066-9168 - Phone
- (937) 886-1510
- Fax
- (937) 886-1505
- NPI assigned
- Aug 4, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT.001497 | OH | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT.001497 | OH | Yes |
Addresses
Primary practice location
90 Remick Blvd
Springboro, OH 45066-9168
Mailing address
90 Remick Blvd
Springboro, OH 45066-9168
Phone (937) 886-1510
Other providers in Springboro, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.