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General NPI Number Information
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NPI Number | 1023462645
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Entity Type | Organization
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Legal Business Name | UNIVERSAL ATHLETIC CLUB
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 2323 OREGON PIKE
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City | LANCASTER
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State | PA
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Zip | 17601-4608
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Country | US
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Telephone | 717-569-5396
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Fax | 717-569-4989
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Provider Business Mailing Address
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Address Line | 2323 OREGON PIKE
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City | LANCASTER
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State | PA
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Zip | 17601-4608
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Country | US
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Telephone | 717-569-5396
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Fax | 717-569-4989
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Authorized Official
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Title or Position | DIRECTOR
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Name | BLAISE CASSELBURY
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Credential |
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Telephone | 717-471-5424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN003167
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License Number State | PA
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