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General NPI Number Information
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NPI Number | 1013435312
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Entity Type | Individual
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Provider Name | MIKE RALPH SITLER EDD, ATC, FNATA
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Gender | Male
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 1800 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19121-3302
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Country | US
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Telephone | 215-204-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 161 SUNSET DR
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City | RICHBORO
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State | PA
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Zip | 18954-1857
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Country | US
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Telephone | 215-953-0848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT000632B
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License Number State | PA
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