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General NPI Number Information
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NPI Number | 1043449721
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Entity Type | Organization
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Legal Business Name | GEISINGER SPORTS MEDICINE
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 109 WOODBINE LN
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City | DANVILLE
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State | PA
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Zip | 17821-9118
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Country | US
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Telephone | 570-275-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 321 WALL ST
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City | DANVILLE
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State | PA
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Zip | 17821-1743
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Country | US
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Telephone | 570-275-3521
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Fax |
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | MR. MATTHEW L GELBAUGH
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Credential | ATC
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Telephone | 570-275-3521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | RT001719A
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License Number State | PA
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