Healthcare Provider Details

I. General information

NPI: 1821062761
Provider Name (Legal Business Name): SCOTT P KIMBEL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W CHURCH ST
DENVER PA
17517-9242
US

IV. Provider business mailing address

109 W CHURCH ST
DENVER PA
17517-9242
US

V. Phone/Fax

Practice location:
  • Phone: 717-587-3497
  • Fax: 717-391-8669
Mailing address:
  • Phone: 717-587-3497
  • Fax: 717-391-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001657A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: