Healthcare Provider Details

I. General information

NPI: 1568975241
Provider Name (Legal Business Name): REBECCA BARTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 09/08/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 EAST AREA LOCKER ROOM BUILDING
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

102 EAST AREA LOCKER ROOM BUILDING
UNIVERSITY PARK PA
16802
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-8296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
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: