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NPI 1811436207

NPI 1811436207 : JESSICA LYNN FALVO MED, LAT, ATC, CES : PITTSBURGH, PA

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General NPI Number Information
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    NPI Number           |    1811436207
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    Entity Type          |    Individual 
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    Provider Name        |    JESSICA LYNN FALVO MED, LAT, ATC, CES
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/17/2017
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    Last Update Date     |    02/17/2017
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Provider Practice Location Address
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    Address Line         |    3200 S WATER ST 
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    City                 |    PITTSBURGH
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    State                |    PA
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    Zip                  |    15203-2307
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    Country              |    US
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    Telephone            |    724-421-7023
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    157 BERTHA ST 
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    City                 |    PITTSBURGH
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    State                |    PA
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    Zip                  |    15211-1557
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    Country              |    US
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    Telephone            |    724-421-7023
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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       |    RT004907
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    License Number State |    PA
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