Healthcare Provider Details

I. General information

NPI: 1831128289
Provider Name (Legal Business Name): MARY ELIZABETH POPOVICH ATC, EMT-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 3RD ST
WEST NEWTON PA
15089-1529
US

IV. Provider business mailing address

119 N 3RD ST
WEST NEWTON PA
15089-1529
US

V. Phone/Fax

Practice location:
  • Phone: 724-972-3779
  • Fax: 724-872-2935
Mailing address:
  • Phone: 724-972-3779
  • Fax: 724-872-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: