Healthcare Provider Details

I. General information

NPI: 1285606871
Provider Name (Legal Business Name): GIAMPIETRO LUCIANO VAIRO PHD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 J RECREATION BLDG THE PENNSYLVANIA STATE UNIVERSITY
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

642 OAKWOOD AVE D
STATE COLLEGE PA
16803-2650
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-2725
  • Fax: 814-865-1151
Mailing address:
  • Phone: 412-225-5276
  • Fax: 814-865-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00128500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003136
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: