Healthcare Provider Details

I. General information

NPI: 1922995299
Provider Name (Legal Business Name): OLIVIA GRACE VRANICH ATC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W OLNEY AVE
PHILADELPHIA PA
19141-1199
US

IV. Provider business mailing address

245 WOLGEMUTH DR
LANCASTER PA
17602-6200
US

V. Phone/Fax

Practice location:
  • Phone: 609-661-0405
  • Fax:
Mailing address:
  • Phone: 717-490-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: