Healthcare Provider Details

I. General information

NPI: 1538662416
Provider Name (Legal Business Name): CARLEY ANN CHARLES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 S GEORGE ST
YORK PA
17403-5009
US

IV. Provider business mailing address

48 FRESH MEADOW DR
LANCASTER PA
17603-6400
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005299
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: