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General NPI Number Information
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NPI Number | 1528052537
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Entity Type | Individual
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Provider Name | CHRISTOPHER ALAN FERTAL ATC.,EMT,CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1101 CITY AVE
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3418
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Country | US
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Telephone | 610-645-5089
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Fax | 610-658-5616
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Provider Business Mailing Address
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Address Line | 279 CONGRESS AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1206
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Country | US
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Telephone | 610-960-6822
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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 | RT003258
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License Number State | PA
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