Healthcare Provider Details

I. General information

NPI: 1225442635
Provider Name (Legal Business Name): JOANNA M ENTZ MS, LAT , ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA BALTZ

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 N WAGNER CIR
SINKING SPRING PA
19608-8938
US

IV. Provider business mailing address

502 WASHINGTON AVE
JERSEY SHORE PA
17740-1228
US

V. Phone/Fax

Practice location:
  • Phone: 610-207-8604
  • Fax:
Mailing address:
  • Phone: 610-207-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005937
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: