Healthcare Provider Details

I. General information

NPI: 1699805192
Provider Name (Legal Business Name): SUSAN SPONSLER KLINEDINST A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YORK COLLEGE OF PA COUNTRY CLUB ROAD
YORK PA
17405-7199
US

IV. Provider business mailing address

3750 COLONIAL RD
YORK PA
17315-3222
US

V. Phone/Fax

Practice location:
  • Phone: 717-849-1613
  • Fax: 717-849-1628
Mailing address:
  • Phone: 717-848-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT000593A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: