Healthcare Provider Details

I. General information

NPI: 1477358273
Provider Name (Legal Business Name): MEGAN RILEY SMITH ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 SHORTLIDGE RD BLDG GYM
STATE COLLEGE PA
16802-4544
US

IV. Provider business mailing address

1220 GHANER RD
PORT MATILDA PA
16870-7203
US

V. Phone/Fax

Practice location:
  • Phone: 814-826-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008492
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: