Healthcare Provider Details

I. General information

NPI: 1952484529
Provider Name (Legal Business Name): HENRY MICHAEL FIJALKOWSKI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PUCILLO DR MILLERSVILLE UNIVERSITY
MILLERSVILLE PA
17551
US

IV. Provider business mailing address

281 ROCK HILL RD
MILLERSVILLE PA
17551-9738
US

V. Phone/Fax

Practice location:
  • Phone: 717-872-3870
  • Fax: 717-871-2449
Mailing address:
  • Phone: 717-871-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT000119A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: