Healthcare Provider Details

I. General information

NPI: 1710219811
Provider Name (Legal Business Name): PAUL THOMAS SWEENEY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

109 N THOMAS AVE APT. 3
KINGSTON PA
18704-5533
US

V. Phone/Fax

Practice location:
  • Phone: 570-466-4109
  • Fax:
Mailing address:
  • Phone: 570-466-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: