Healthcare Provider Details

I. General information

NPI: 1508134784
Provider Name (Legal Business Name): MATTHEW STAUB MS, ATC, CSCS, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EXPEDITION TRL STE 101
GETTYSBURG PA
17325-8599
US

IV. Provider business mailing address

20 EXPEDITION TRL STE 101
GETTYSBURG PA
17325-8599
US

V. Phone/Fax

Practice location:
  • Phone: 717-334-4033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059168
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002433A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: