Healthcare Provider Details

I. General information

NPI: 1851821821
Provider Name (Legal Business Name): MICHAEL FRANCIS FLEMING JR. MS, LAT, ATC, CSCS,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 WOODLAND DR
SPRING GROVE PA
17362-8623
US

IV. Provider business mailing address

7369 WOODLAND DR
SPRING GROVE PA
17362-8623
US

V. Phone/Fax

Practice location:
  • Phone: 717-600-7621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004137
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRT004137
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPROVIDER CODE 22

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: