Healthcare Provider Details

I. General information

NPI: 1396899597
Provider Name (Legal Business Name): JASON P JARINKO ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WOODBINE LN
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

115 WOODBINE LN
DANVILLE PA
17822-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-5096
  • Fax: 570-214-6700
Mailing address:
  • Phone: 570-214-5096
  • Fax: 570-214-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002369A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: