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General NPI Number Information
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NPI Number | 1083634125
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Entity Type | Individual
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Provider Name | MALVIN CARRION A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST DEPARTMENT OF ORTHOPAEDIC,5TH FLOOR, OUTPATIENT BLD.
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-2111
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Fax | 215-707-2324
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Provider Business Mailing Address
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Address Line | 4405 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1205
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Country | US
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Telephone | 215-333-0925
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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 | RT002045A
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License Number State | PA
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