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General NPI Number Information
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NPI Number | 1629440276
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Entity Type | Individual
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Provider Name | MATTHEW RAY REBUCK LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 1160 MANHEIM PIKE
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City | LANCASTER
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State | PA
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Zip | 17601-3127
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Country | US
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Telephone | 717-903-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 2088 POWDERHORN RD
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City | MIDDLETOWN
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State | PA
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Zip | 17057-5971
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Country | US
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Telephone | 717-903-0016
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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 | RT006257
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License Number State | PA
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