Healthcare Provider Details

I. General information

NPI: 1942817986
Provider Name (Legal Business Name): TIMOTHY GOLDINGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 UNIVERSITY BLVD
MOON TWP PA
15108-2574
US

IV. Provider business mailing address

6001 UNIVERSITY BLVD
MOON TWP PA
15108-1189
US

V. Phone/Fax

Practice location:
  • Phone: 412-397-4916
  • Fax:
Mailing address:
  • Phone: 412-397-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005771
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: