Healthcare Provider Details

I. General information

NPI: 1689755514
Provider Name (Legal Business Name): LORI A SWEENEY PH.D, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI A RAFFERTY PH.D, ATC

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 CITY AVE SPORTS MEDICINE
PHILADELPHIA PA
19131-1308
US

IV. Provider business mailing address

167 WOODBINE RD
HAVERTOWN PA
19083-3524
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-1699
  • Fax: 610-660-2577
Mailing address:
  • Phone: 610-637-8583
  • Fax: 610-660-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001380A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: