Healthcare Provider Details

I. General information

NPI: 1194263889
Provider Name (Legal Business Name): JEFFREY ROBERT HARMAN LAT., ATC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 PARK CIR APT. A
CLARION PA
16214-1777
US

IV. Provider business mailing address

407 PARK CIR APT. A
CLARION PA
16214-1777
US

V. Phone/Fax

Practice location:
  • Phone: 717-307-0195
  • Fax:
Mailing address:
  • Phone: 717-307-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT006333
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: