Healthcare Provider Details

I. General information

NPI: 1104207992
Provider Name (Legal Business Name): MICHAEL SWEITZER JR. MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LINDEN ST
SCRANTON PA
18510-4501
US

IV. Provider business mailing address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

V. Phone/Fax

Practice location:
  • Phone: 570-941-7473
  • Fax:
Mailing address:
  • Phone: 570-892-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004268
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: