=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407263858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG HARTMAN A.T.C., L.A.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 07/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 855 S NEW ST
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19383-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-926-8235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 EASTFIELD DR
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-926-8235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------