Healthcare Provider Details

I. General information

NPI: 1285519025
Provider Name (Legal Business Name): KAYLA ANN HARTZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD MAIN
UNIVERSITY PARK PA
16802-1503
US

IV. Provider business mailing address

1481 CORTEZ RD
BLUE BELL PA
19422-3672
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-4700
  • Fax:
Mailing address:
  • Phone: 215-803-5120
  • 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 Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

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: