Healthcare Provider Details

I. General information

NPI: 1841652617
Provider Name (Legal Business Name): ALYONA VASYLENKO LAT,ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD SUITE 290
YORK PA
17403-5060
US

IV. Provider business mailing address

719 S HAMPTON AT WATERFORD
YORK PA
17402-7868
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax:
Mailing address:
  • Phone: 570-778-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT006168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: