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General NPI Number Information
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NPI Number | 1972988061
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Entity Type | Individual
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Provider Name | DEREK BEELER PHD, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 501 E. 38TH STREET MAC 203
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City | ERIE
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State | PA
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Zip | 16546-1823
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Country | US
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Telephone | 814-824-2926
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E. 38TH STREET MAC 203
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City | ERIE
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State | PA
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Zip | 16546-1823
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Country | US
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Telephone | 814-824-2926
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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 | RT007857
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License Number State | PA
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