Healthcare Provider Details

I. General information

NPI: 1770547234
Provider Name (Legal Business Name): ARTHUR G FATINO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL LN
BLAIRSVILLE PA
15717-8709
US

IV. Provider business mailing address

500 LINTNER RD APT D
BLAIRSVILLE PA
15717-7969
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-3696
  • Fax:
Mailing address:
  • Phone: 724-459-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT00254A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: