Healthcare Provider Details

I. General information

NPI: 1427408160
Provider Name (Legal Business Name): CAMERON DANIEL PATRIA MED, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST AREA LOCKER BLDG
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

201 EAST AREA LOCKER BLDG
UNIVERSITY PARK PA
16802
US

V. Phone/Fax

Practice location:
  • Phone: 814-206-6874
  • Fax:
Mailing address:
  • Phone: 814-206-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005014
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: