Healthcare Provider Details

I. General information

NPI: 1538417712
Provider Name (Legal Business Name): BRITTANY PLUMMER ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W WATER ST APARTMENT 3
LOCK HAVEN PA
17745-1296
US

IV. Provider business mailing address

18 WINDY HEIGHTS RD
CALIFON NJ
07830-4371
US

V. Phone/Fax

Practice location:
  • Phone: 908-752-1637
  • Fax:
Mailing address:
  • Phone: 908-752-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005260
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: