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General NPI Number Information
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NPI Number | 1235763517
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Entity Type | Individual
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Provider Name | ALYSON HANSBARGER LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 1801 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19122-6003
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Country | US
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Telephone | 215-622-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 124 EQUESTRIAN CT
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City | PERKASIE
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State | PA
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Zip | 18944-2829
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Country | US
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Telephone | 215-622-1213
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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 | RTO000414
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License Number State | PA
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