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General NPI Number Information
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NPI Number | 1437625530
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Entity Type | Individual
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Provider Name | KELSEY SARA REICH LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 400 SHARP AVE
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City | LAURELDALE
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State | PA
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Zip | 19560
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Country | US
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Telephone | 484-955-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 3 TAMMY LOUISE DR
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City | FLEETWOOD
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State | PA
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Zip | 19522-8878
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Country | US
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Telephone | 484-706-0533
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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 | RT007083
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License Number State | PA
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