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General NPI Number Information
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NPI Number | 1245327675
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Entity Type | Individual
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Provider Name | RYAN ALAN HARTER ATC
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 2775 SCHOENERSVILLE RD
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City | BETHLEHEM
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State | PA
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Zip | 18017-7307
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Country | US
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Telephone | 610-816-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 609 GOLDEN EAGLE DR
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City | SAYLORSBURG
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State | PA
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Zip | 18353-7995
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Country | US
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Telephone | 716-998-0187
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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 | 001215-1
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License Number State | NY
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