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General NPI Number Information
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NPI Number | 1770632242
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Entity Type | Individual
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Provider Name | JENNIFER MARYNIAK ATC, MED., CSCS
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SHARP & FRANCIS STREETS
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City | LAURELDALE
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State | PA
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Zip | 19605
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Country | US
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Telephone | 610-921-8078
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Fax | 610-921-7922
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Provider Business Mailing Address
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Address Line | 2 MUSKET LN
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City | SHILLINGTON
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State | PA
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Zip | 19607-9541
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Country | US
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Telephone | 610-921-8078
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Fax | 610-921-7922
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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 | RT001529A
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License Number State | PA
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