Healthcare Provider Details

I. General information

NPI: 1659414290
Provider Name (Legal Business Name): JOHN THOMAS FERDINAND MED, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 UNIVERSITY DRIVE PENN STATE UNIVERSITY
HAZLETON PA
18201
US

IV. Provider business mailing address

35 FREEDOM RD
DRUMS PA
18222-2720
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-3142
  • Fax:
Mailing address:
  • Phone: 570-788-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT000755A
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: