Healthcare Provider Details

I. General information

NPI: 1093709123
Provider Name (Legal Business Name): JENNIFER M. WUYSCIK MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TROY HILL RD
PITTSBURGH PA
15212-5124
US

IV. Provider business mailing address

108 GRIMM RD
SARVER PA
16055-9239
US

V. Phone/Fax

Practice location:
  • Phone: 412-321-4823
  • Fax: 412-321-0599
Mailing address:
  • Phone: 412-321-4823
  • Fax: 412-321-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002186A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: