Healthcare Provider Details

I. General information

NPI: 1285088096
Provider Name (Legal Business Name): SARA TALARICO MED, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 VINE STREET
SCRANTON PA
18509
US

IV. Provider business mailing address

245 KATHLEEN DRIVE
PECKVILLE PA
18452
US

V. Phone/Fax

Practice location:
  • Phone: 187-734-6355
  • Fax:
Mailing address:
  • Phone: 570-241-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004569
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: