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General NPI Number Information
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NPI Number | 1861417826
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Entity Type | Individual
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Provider Name | KELLY ALISON STALKER ATC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1145 KING RD
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City | IMMACULATA
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State | PA
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Zip | 19345-9903
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Country | US
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Telephone | 610-647-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 2 VICTORY WAY
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City | LIMERICK
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State | PA
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Zip | 19468-1342
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Country | US
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Telephone | 610-812-4333
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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 | RT-002345-A
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License Number State | PA
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